Introduction
Hallux rigidus describes an arthritic change with an associated increase in bony tissue at the metatarsophalangeal joint of the big toe, which can be very painful and significantly affects the movement and rolling motion of the foot.
Operation of the hallux rigidus
Basically, the most promising conservative therapy for hallux rigidus is rarely used and the most common surgical therapy for hallux rigidus is possible:
- Cheilectomy: In cheilectomy (see below), the bony hump on the back of the foot (rosy spur) is removed from the first metatarsal head and the joint edges are smoothed. In addition, tendon adhesions are removed. If sufficient extension is not possible afterwards, the basic limb is also repositioned to allow for good rolling.
- Supply with a prosthesis:Under certain conditions a biocompatible artificial joint can be inserted.
This combines good mobility with good foot handling. However, such an artificial joint can loosen up, which can lead to subsequent operations. Unfortunately, the durability and resilience of these prostheses is limited.
- Operation according to Keller-Brandes: The operation according to Keller-Brandes (see below) is a joint-removing operation, with removal of 1/3-2/3 of the base limb of the big toe.
This procedure is only to be used in older patients, as it disregards biomechanics.
- Arthrodesis (stiffening) of the joint:In younger, athletically active patients, a selective fusion of the metatarsophalangeal joint of the big toe is recommended, which allows for a painless and powerful rolling motion. The movement in the final joint is maintained
Consequences of the arthrotic changes in a hallux rigidus include a narrowing of the joint space, an increase in bone tissue on the joint surface and pebble cysts under the cartilage layer. The arthrosis results in impairment of the entire joint including mobility and severe pain.
The reason for the pain is mainly the irritation of the joint capsule and the bones, which are both very well supplied with nerves. Especially the rolling motion of the foot causes pain, which causes a gentle position of the metatarsophalangeal joint of the big toe. If conservative methods, such as painkillers or a rigid sole splint, fail, a surgical intervention that affects the bony structures may be necessary. However, this procedure is also associated with pain:
- On the one hand, typical post-operative pain is caused by the healing of the wound.
- On the other hand, numerous structures are injured and irritated during the operation, for example the periosteum or nerves, some of which can cause pain beyond the period of wound healing.
- The joint may also have been changed by the operation in such a way that it no longer hurts due to the arthrosis, but the new joint structure means that it must learn a new movement and causes pain.
