Introduction
A so-called hallux rigidus is caused by long-term joint wear, i.e. arthrosis in the metatarsophalangeal joint of the big toe. This leads to an increasing painful stiffening of the joint. In some cases, a hallux rigidus occurs in combination with a hallux valgus (a foot malposition in which the toe points to the outside of the foot), which can worsen the symptoms. Cheilectomy is a surgical therapy method for the treatment of rather milder forms of the disease, but where all conservative methods have already been exhausted.
Symptoms
The increasing stiffness of the metatarsophalangeal joint of the big toe hinders the normal rolling movement of the foot, which is essential when walking. This causes severe pain. Since the rolling movement can only be insufficiently compensated, soon neither walking nor running will be possible without pain.
A hallux rigidus can also be recognized by a reduced dorsal extension (pulling the toes upwards), an inflammation of the joint with possible swelling and bony attachments to the existing foot bones (osteophytes). Osteophytes on the heads of the metatarsal bones are particularly common. Patients can no longer stand on their toes, climb stairs or walk uphill without symptoms. An x-ray generally confirms the diagnosis.
Causes
Hallux rigidus is the result of arthrosis of the joint, which has developed over a long period of time. In part, its occurrence is genetically determined, but there are also some known factors that specifically favor the development of this disease. Cartilage damage Cartilage damage of all kinds, for example – as can be caused by accidents or sports injuries – as well as metabolic disorders, incorrect loading of the foot due to joint malpositions, but also general overloading of the joints, considerably accelerate the process of arthrosis.
Indication
Cheilectomy should always be performed when all conservative treatment options have been exhausted and there is no significant improvement in symptoms. On the other hand, wear and tear of the joint should not have progressed too far, so that there is justified hope for a joint-preserving procedure. The metatarsophalangeal joint of the big toe should still have good mobility and sufficient cartilage; if more than 50% of the cartilage mass is lost, it is already too late for a cheilectomy. It is then no longer the method of choice and should be replaced by a more radical surgical procedure.
All articles in this series: