The operation of the hallux rigidus

A variety of procedures are available for the operation of hallux rigidus. Each procedure must be adapted to the patient’s condition, the stage of the disease and of course to the desired result. Surgery is only considered in the later stages, while the early stages are treated conservatively.

In the middle stages of the disease, surgery should be performed to preserve the joint in any case. One procedure that comes into consideration here is the so-called cheilectomy. This involves opening the joint capsule.

After removal of a part of the joint membrane, the cartilage is inspected. In the area of the joint cartilage, protruding parts (ostephytes) are removed and the cartilage as a whole is smoothed in the area of the joint. After extensive irrigation, the wound is then closed again.

With this method, the relevant parts of the joint and the ligament and tendon apparatus remain intact. Due to the low invasiveness, later operations with other methods are still possible. This method is comparable to the smoothing often used in the knee joint in a knee endoscopy.

After the operation, movement exercises and loading with the help of a thick sock should be started as soon as possible. Another method to restore the mobility of the big toe joint is the osteotomy of the base phalanx. A wedge is cut out of the metatarsal bone from above.

The bony layer towards the sole of the foot remains intact at first and is then slightly broken open to close the wedge-shaped incision. In this surgical method, the result is then stabilized with clamps or screws. After the operation, a rigid shoe must be worn for 6 weeks to stabilize the foot until the bone has healed firmly.

This technique can be applied to various bones of the foot, but always has the effect that by cutting out a wedge or disc, the position of the joint head is changed to allow greater mobility and minimize the risk of incorrect loading. Arthrodesis is another procedure that is used, especially in patients who require high load stability. During arthrodesis, the affected joint is stiffened.

The aim of the whole procedure is to firmly connect the bones of the big toe and the metatarsus by means of a bony extension. The original joint area including cartilage and joint surface is replaced by this ossification. During the operation, the joint is removed and the bony surfaces are joined together.

This construction must first be stabilized with nails or screws until the resulting bone can handle this task on its own. This technique also results in variations, depending on the exact symptoms. In the so-called lapidus arthrodesis, for example, the joint between the metatarsal and the tarsus is stiffened.

In addition to screws for stabilization, plates are also used. After the operation, the foot should be elevated for a few days. The big toe itself should then not be loaded for about 6 weeks to allow the bone to achieve a certain degree of stability.

The arthrodesis changes the rolling motion of the foot under load. This is particularly useful to prevent pain. In contrast to prosthetic procedures, there is no risk of later loosening.

90 % of patients report being satisfied with the result after the operation. The replacement of the metatarsophalangeal joint of the big toe with a prosthesis is also possible in the case of hallux rigidus. The main advantage of prostheses is that the natural mobility of the joint is maintained or restored as far as possible.

Thus, the restrictions after the operation should be less severe.However, even with these prostheses it is no longer permitted to perform activities that are subject to maximum stress. The prosthesis is fitted in a similar way to the knee joint, for example, and adjusted to the anatomical characteristics. This procedure is now regarded as standard in many places.

In addition to mobility, the advantages also include rapid pain relief. In addition, should problems arise with the prosthesis, the very gentle fitting procedure means that an intervention with another procedure is also possible at a later date. Here, too, a shoe with a stable sole should be worn for about 6 weeks and rolling should be avoided. After 6 weeks, however, the prosthesis should be well bonded to the bone so that loading is possible.