The hallux rigidus describes the degenerative change of the metatarsophalangeal joint of the big toe up to stiffening. There is a decrease in cartilage mass and quality, recurring painful inflammation in the joint and increasingly limited joint function. Similar to osteoarthritis, which is often the cause of hallux rigidus, the partial complete loss of cartilage surface in the late stage can lead to bone-on-bone movement, which is very painful.
Therapy
Therapy for hallux rigidus begins with conservative measures and aims to maintain joint mobility as far as possible and to enable a pain-free gait pattern. For this purpose, physiotherapy can be used, in which the toe can be mobilized manually, but also the patient himself learns exercises to improve joint supply and mobility. The development of a physiological gait pattern to protect other structures is also part of the treatment program of physiotherapy.
In addition, painkillers such as ibuprofen or diclofenac (non-steroidal anti-inflammatory drugs) can be helpful over a short period of time, especially in cases of severe pain and acute inflammatory conditions, e.g. due to abrasion products in the joint. Even if these drugs are freely available, it should be remembered that they are serious drugs with side effects. Their use should be considered and medical advice should be sought urgently for long-term use.
To protect the joint from mechanical overload, certain splints or shoe insoles as well as tape bandages can support the treatment. It is important to bear in mind that these aids are passive supports that can further promote the breakdown of the musculature and thus lead to a certain dependency. If the pain is resistant to therapy and very severe, surgical therapy with subsequent rehabilitation can alleviate the patient’s symptoms. Various surgical techniques are available, which should be individually coordinated between the surgeon and patient.
Exercises
To prevent hallux rigidus and counteract stiffening, mobilization exercises can be helpful. Care should always be taken to train the joint only in the pain-free area, since overloading the affected structures can easily cause inflammation, which could further promote stiffening. 1.)
The patient can passively mobilize the toe on his own by grasping the toe close to the joint, i.e. with one hand just below the joint and with the other hand grasping the toe just above the joint. The lower hand fixes the midfoot and the upper hand can now mobilize the toe bone in the joint. A light pull can also be applied, which releases the joint surfaces from each other and can thus lead to a pleasant relief.
The manual stretching and mobilization of the arch of the foot and the back of the foot can also be pleasant. 2.) Gripping exercises can be used as further exercises.
In case of acute pain, these can also be performed in a warming or cooling medium. For example, the patient can grasp a grain pillow with his toes or a package of frozen peas. An individual combination of exercises to correct the patient’s statics and posture can prevent overloading of the metatarsophalangeal joint of the big toe. Further exercises can be found in the articles:
- Exercises for a hallux rigidus
- Exercises for metatarsophalangeal joint arthrosis of the big toe