Operation/Stiffening

Joint deformities often occur in the metatarsophalangeal joint of the big toe. Due to the reduced load capacity of the cartilage, cusp formation (osteophytes) occurs. These not only restrict mobility, but can also lead to space problems in shoes, for example.

Tissue can be irritated or damaged by constant pressure. Surgical removal of these attachments can provide considerable relief as long as the metatarsophalangeal joint of the big toe is not affected, i.e. at an early stage. One speaks of a so-called cheilectomy.

If the joint is already affected, functional mobility is limited and therapy-resistant rolling pain occurs, an attempt is first made to preserve the joint. Several surgical options are available. Artificial joints are also used in the meantime, although still rarely.

Since the metatarsophalangeal joint of the big toe is very heavily loaded during gait, it is questionable how stable an endoprosthesis will hold in the joint permanently. The follow-up treatment of the operation takes about 6 weeks.

The so-called repositioning osteotomy.
Here, the joint partners are removed from each other so that the metatarsophalangeal joint of the big toe is relieved. In most cases, a part of the metatarsal bone is removed to give the metatarsophalangeal joint more space. Pain can be alleviated and mobility is maintained.
Surgical joint stiffening (arthrodesis) irrevocably eliminates joint mobility, the joint is fixed in a certain position.
The patient can now no longer move the metatarsophalangeal joint of the big toe, but can walk, run and sometimes even do sports without pain. There are various forms of joint stiffening.

Manual treatments can also be helpful; the patient can massage his foot, mobilizing the individual toes, flexing the metatarsals against each other and stretching the arch of the foot. So-called traction is particularly relieving for the metatarsophalangeal joint of the big toe.

Here, the foot is gripped close to the joint and then a gentle pull is applied to the joint. The joint surfaces are released from each other and the cartilage is relieved.Exercises after an operation should always include the surrounding joints. Compensatory movements in the ankle or knee joint can occur due to a previous relieving posture or due to joint stiffening. If this is the case, the affected joint must be relieved and the surrounding musculature must be trained to avoid overstraining the joint. If the patient has a manifest relieving posture, it should be trained as far as possible after the operation to avoid overloading other joints.