Foot pain is immediately perceived as restricting movement. If the normal rolling process over the big toe is not possible without pain in the long term, an arthrosis such as hallux rigidus can be the cause. This disease does not only affect older people.
What is hallux rigidus?
Hallux rigidus is the term used to describe osteoarthritis of the metatarsophalangeal joint of the big toe. The disease first appears with pain and a clearly visible circumferential expansion at the ball of the foot and can gradually lead to stiffening of the joint. The characteristic feature is the restricted movement of the big toe. Hallux rigidus usually only appears on one foot and occurs regardless of age, but more frequently in men than in women. Depending on the severity of the disease, hallux rigidus is divided into four stages, which are represented by an increase in pain and restricted movement.
Causes
A cause for the occurrence of hallux rigidus can usually not be found. A hereditary predisposition as well as small injuries to the metatarsophalangeal joint can be a possible cause. Likewise, incorrect loading or overloading can play a role. In patients with gout, hallux rigidus occurs more often because the longitudinal arch of the foot is flattened and the foot is bent inward as a result. This results in an incorrect load on the metatarsophalangeal joint of the big toe and thus hallux rigidus.
Symptoms, complaints and signs
The main symptom of hallux rigidus is pain in the area of the big toe. These are usually permanent, but can become more severe with particular stress and movement. In this case, the big toe can only be moved upwards with severe pain. In advanced hallux rigidus, the joint may also be completely blocked. It may be possible to hear pieces of cartilage and bone rubbing against each other when the joint is moved. Usually, swelling may be noticed as well as sometimes redness. Especially in the case of incipient hallux rigidus, the short muscles of the foot may visibly twitch. Bony extensions often form on the dorsum of the foot above the big toe. These are usually very sensitive to pressure. When stepping with the affected foot, pain occurs. For this reason, the foot position also changes increasingly. The foot is not rolled properly when walking. The affected person touches down with the outer edge of the foot, which can also cause calluses to develop in the affected areas. After some time, the joint becomes increasingly stiff. In addition, patients with hallux rigidus often notice a lack of space in the shoe. The complaints increase at low temperatures. As a rule, only one foot is affected by hallux rigidus.
Diagnosis and progression
The doctor can diagnose hallux rigidus based on an examination and the patient’s medical history. X-rays are taken to determine the severity of the condition. In 1st-degree hallux rigidus, the range of motion of the big toe is reduced by 20 to 50 percent, and pain is already evident at times during exertion. In 2nd degree, the ability to move is reduced to up to 75 percent with severe pain. The joint space is shown reduced on the X-ray. The 3rd degree is characterized by a further restriction of movement, whereby the big toe can no longer be moved upwards. Patients suffer constant pain, which worsens when walking. The joint space is almost non-existent. In 4th degree hallux rigidus, there is complete immobility of the metatarsophalangeal joint. The pain is very severe and increases when the foot is loaded. In the worst form of hallux ridigus, the x-ray shows no existing joint space.
Complications
Hallux rigidus causes severe pain in the foot in most cases. Due to this pain, there are mainly movement restrictions. Ordinary running, walking and standing is usually no longer possible. Likewise, sporting activities are no longer feasible for the affected person. The movement restrictions and the permanent pain often lead to depression and other psychological complaints. Under certain circumstances, irritability or aggressiveness may also develop in the patient. The foot is misloaded by hallux rigidus, so that the complaints usually only increase if no treatment is given.The patient is severely restricted in his everyday life by the disease and can no longer perform various activities without further ado. This results in a severe reduction in the quality of life. The treatment of hallux rigidus does not lead to further complications. It takes place with the help of medication or surgical interventions and in most cases leads to a positive course of the disease. In some cases, a part of the big toe has to be removed. Life expectancy is not affected by hallux rigidus.
When should you see a doctor?
Since there is severe pain due to hallux rigidus, examination and treatment by a doctor is inevitable. Further complications can be avoided in this way. As a rule, the doctor should be consulted for hallux rigidus when there are severe restrictions on the big toe due to the disease. In this case, the toe hurts, and the pain itself can also spread to the entire foot. Hallux rigidus also causes incorrect weight-bearing on the foot, so that the person affected often has to adopt an incorrect posture or a protective posture. Limping or limping can also indicate the disease. If the complaints cannot be explained by an accident and occur over a longer period of time, a visit to a doctor is definitely recommended. Diagnosis and treatment of hallux rigidus can be done by an orthopedist or a general practitioner. As a rule, the symptoms are well alleviated with the help of insoles. No particular complications occur.
Treatment and therapy
Depending on the stage of hallux rigidus, different treatment options arise. For 1st- and 2nd-degree arthritis, conservative treatments are the main focus. They are designed to relieve pain and swelling and reduce stress on the joint. These include anti-inflammatory medications and shoe inserts. Physical therapy exercises can help improve joint mobility. However, this does not reverse the wear and tear on the joint. In addition, patients should avoid tight shoes. Footwear with plenty of room for the toes and the ball of the foot are also suitable for orthopedic insoles. Up to 2nd degree hallux rigidus, surgical removal of the bony prominences can also be performed. Cheilectomy is intended to restore range of motion. The selection of the correct surgical procedure depends on the patient’s age and activity level. In younger patients, arthrodesis is often the surgery of choice. Here, the basic joint is stiffened. Pain-free rolling is then possible again, because the mobility in the end joint of the toe is retained. Keller-Brandes surgery is primarily performed on older patients because part of the proximal phalanx of the big toe is removed, shortening it. The use of a joint prosthesis is also possible in hallux rigidus. However, the durability and load-bearing capacity of these prostheses are limited, making replacement operations necessary.
Outlook and prognosis
As long as the stiffening of the big toe is in the early stages, there is a good chance of recovery. Then there is no need to undergo surgery. Numerous conventional treatment methods are available. These include taking body-building substances, anti-inflammatory drugs, orthopedic shoe inserts and, for example, physiotherapy. The situation is different in cases of severe progression of the disease. Then standing and walking is only possible with pain. Long distances can no longer be covered. In this case, surgery is the only option. This is associated with similar risks as other operations. Those affected can also help to prevent the hallux rigidus condition from worsening. Especially in the early phase, they are responsible for their own actions. This begins, for example, with the regular wearing of suitable shoes. In wide and soft footwear, the toes find sufficient space and pain does not occur in the first place. Consistent exercise sessions on the big toe also prevent stiffening. Physical therapists introduce sufferers to exercise. This and other advice from specialists and doctors should be followed. This will avoid surgery, the positive outcome of which is not always certain.
Prevention
There is no effective prevention for hallux rigidus. Incorrect stress and overloading should be avoided by wearing suitable footwear.This is especially true for runners, but also for anyone whose job puts a lot of stress on their feet, because hallux rigidus can occur at any age.
Aftercare
In most cases of hallux rigidus, very few measures of aftercare are available to the patient. In this disease, first and foremost, an early diagnosis is very important so that further complications or a worsening of the symptoms can be avoided. An independent cure cannot occur, so that the affected person should see a doctor at the first signs and symptoms of this disease. In most cases of the disease hallux rigidus insoles for the shoes are used to alleviate the discomfort. Medication can also be taken to relieve inflammation. When taking them, it is important to pay attention to the correct dosage and also to take them regularly. In some cases, however, surgical intervention is necessary to permanently alleviate the symptoms. The affected person should rest after the operation and refrain from strenuous or physical activities. If the disease does not appear until older age, a prosthesis can be used to combat the discomfort. Usually, this disease does not negatively affect the life expectancy of the affected person.
What you can do yourself
Since the pain is often very pronounced in an existing hallux rigidus, pain management takes a major role in the therapy. In addition to pain pills, the affected person can resort to over-the-counter pain ointments. Footbaths, compresses and alternating warm sitz baths are also recommended. In addition, it is extremely important to relieve the affected joint in order to inhibit the inflammatory reactions. Physical exertion and sport should therefore be avoided at all costs. Instead, the foot should be elevated and, if necessary, cooled with the aid of cold packs to promote swelling reduction and alleviate the pain. Well-fitting shoes are also very important for hallux rigidus. Shoes should never be too tight. Instead, they should provide enough space for the toes and balls of the feet to avoid pressure points. At the same time, sufficient stability must be guaranteed at all times. Wearing special insoles is also necessary in many cases. The following applies here: If the doctor prescribes insoles, they must be worn regularly – i.e. daily – to increase the chances of successful treatment. If physiotherapy is required, the patient must also cooperate actively here to ensure that improvement occurs quickly.
