OP
In the case of therapy-resistant complaints, a highly advanced hallux rigidus or a severely restricted gait pattern, a surgical procedure is recommended. There are different approaches that should be adapted to the patient. Cheilectomy is recommended for patients whose joint function is severely restricted by bony attachments (osteophytes).
The osteophytes can be removed and irritation of the surrounding structures can be remedied. In the case of a joint repositioning osteotomy, an attempt is made surgically to restore the joint mechanics as far as possible. The joint axes can be shifted, attachments and abrasion products can be removed so that the joint can work as physiologically as possible. In severe cases, an artificial arthrodesis (stiffening) can be performed, which completely eliminates joint mobility, but usually allows painless walking. The use of artificial joint replacement for the metatarsophalangeal joint of the big toe is controversial.
Summary
Hallux rigidus is a degenerative disease of the metatarsophalangeal joint of the big toe, which is often caused by arthrosis in the joint and can lead to stiffening of the joint. It also leads to changes in the surrounding tissue. The joint capsule becomes less mobile, muscles atrophy, bony attachments to the joint impede physiological rolling and sliding, which further restricts joint mobility.
In the final stage, joint mobility is completely eliminated. The joint is stiff. This is followed by changes in the gait pattern because the metatarsophalangeal joint of the big toe plays an enormously important role in the rolling movement.
Long-term protective postures can overload and damage other structures, such as the knee or hip joint. Therapy should therefore begin as early as possible. Therapy is usually initially performed conservatively using physiotherapeutic mobilization techniques, splinting, orthopedic footwear (spring) or bandages.
The use of doses of painkillers can be helpful. If pain is resistant to therapy or the gait pattern is severely restricted, surgery (cheilectomy, repositioning osteotomy or arthrodesis) can improve the symptoms.
