Introduction
Hallux rigidus is the name given to arthrosis of the metatarsophalangeal joint of the big toe. Literally translated, hallux rigidus means “stiff big toe”. The main symptom of hallux rigidus is pain.
This is usually permanent, but becomes more intense when the joint is stressed, i.e. ultimately during all movements. In addition, the joint is often swollen and/or reddened, which is caused on the one hand by bony pulls and on the other hand by a subsequent inflammatory reaction. The swelling further restricts mobility.
The symptom of a lack of space in the shoes is often noticeable in patients. Because movement is often avoided as a consequence and the ossifications also narrow the joint space, the joint becomes increasingly stiff over time and walking, especially rolling the foot, becomes increasingly difficult. In many cases, Hallux Rigidus also causes secondary complaints due to incorrect loading of other joints, which is intended to relieve the painful metatarsophalangeal joint of the big toe.
Often this happens completely unconsciously. The metatarsophalangeal joint of the other 4 toes, for example, is subjected to increasing stress and the outer edge of the foot is overstressed, as patients tend to roll the foot over the outer edge due to the stiffness of the big toe. The resulting pain is often diffuse and difficult to localize. Knee and hip joints can also be affected by the incorrect posture.
Pain in hallux rigidus
Pain in the metatarsophalangeal joint of the big toe is one of the most important symptoms of hallux rigidus. The joint partners of the metatarsophalangeal joint of the big toe as a real joint are covered with hyaline cartilage, which is increasingly destroyed in the course of the arthrotic changes in hallux rigidus. The joint cartilage performs important tasks by smoothing the joint surface and thus preventing the development of excessive friction.
It also absorbs compressive forces due to its pressure-elastic properties. Regeneration of the hyaline cartilage is not possible, since cartilage is one of the so-called bradytrophic (characterized by slow metabolism) tissues. The degradation of cartilage mass causes an increase in pressure in the underlying bone, resulting in tiny fractures.
Sometimes the rubbing of cartilage and bone tissue against each other is audible as a crepitus. Tiny pieces of bone or cartilage can come loose and enter the joint space, causing it to block. These degenerative changes cause a lack of resilience and lead to chronic inflammation, which causes great pain, especially when moving.
Characteristic of osteoarthritis pain is the so-called start-up pain, whereby the pain is more pronounced during movement after a preceding resting phase. Hallux rigidus is typically painful after long periods of walking, i.e. when the joint is subjected to heavy strain. In advanced stages, pain also occurs at rest (i.e. independent of load), such as at night.
Many affected persons also describe their complaints as being weather-dependent. The pain in the joint can be provoked mainly by a movement of the big toe towards the tip of the nose (dorsal extension). Due to the inflammatory processes that take place, the area above the metatarsophalangeal joint of the big toe becomes painful under pressure and can swell.
As a result, mobility is severely restricted. Since putting the foot on the ground is perceived as particularly painful (see: Pain in the ball of the foot), the rolling motion of the foot during walking is altered. The incorrect loading can in turn cause new pain and damage other joints.
