Hallux rigidus is an increasing wear of the metatarsophalangeal joint of the big toe. The joint cartilage wears off with age and causes pain especially when walking and, in advanced cases, also at rest. Arthrosis can also be caused by a rheumatic underlying disease or can develop as a result of a malpositioning of the joint.
The pain can lead to a loss of movement up to a stiffening of the joint. In addition, signs of inflammation such as redness and swelling occur. Increasingly, wearing shoes becomes uncomfortable and can cause the patient additional pain. Frequently, the symptoms get worse in colder temperatures.
Conservative therapy
Conservative treatment aims to stop the process from progressing and ultimately prevent arthritis of the metatarsophalangeal joint of the big toe. The patient should be able to walk without pain for as long as possible. Drug therapy with anti-inflammatory drugs is intended to prevent or halt the progression of inflammatory processes that can result from the wear and tear of the cartilage covering the joint.
Inflammation manifests itself through swelling, redness, overheating and pain in the affected joint. Medication can reduce the symptoms and prevent them from spreading to the surrounding tissue. Various pain-relieving drugs can be taken to relieve the pain.
Pain-relieving and at the same time cooling ointments can also be applied to the affected joint and relieve the pain. Physical therapy measures have the goal of relieving pain and promoting the healing process. If applied regularly and professionally, they can provide the patient with times without pain and avoid chronic pain.
Especially the cold therapy has proven to be a healing-promoting measure for inflammatory processes. When using cold applications in the form of ice and cold compresses it should be ensured that the skin is not in direct contact with the cold. Cold can also cause burns, which can damage the vessels and the skin and are often noticed too late by the patient.
Another possibility to treat a hallux rigidus conservatively is offered by various injection procedures. Among others, local anesthetics can be injected into the affected joint. They have a dampening effect on the nerve endings and significantly relieve the pain, since pain is no longer transmitted via the nerves located there.
The affected joint can finally recover and the healing process is thus additionally promoted. Possible medications that are suitable for injections are conventional anti-inflammatory drugs, homeopathic remedies, cortsion and hyaluronic acid. Inflammatory processes can be alleviated by injections of Orthokine.
Orthokines are endogenous hormone-like substances that can counteract and stop inflammatory reactions. In inflammatory processes in joints it is particularly important that the inflammation does not spread to the cartilage. The cartilage has a protective function and protects the bone from wear and tear.
Orthokines can therefore also protect the cartilage covering the joint surfaces from infection. In addition to drug therapy, regular physiotherapy should be carried out. Often, pain relief is necessary in advance so that the exercises can be performed without pain.
The aim of physiotherapy is to reduce the pain with specific exercises and especially to keep the joint flexible. It is especially important to counteract stiffening of the joint, especially in the case of rheumatic diseases. If the conservative treatments are unsuccessful, the patient often has to undergo only one operation to treat the hallux rigidus.
There are different operations to treat the disease. It depends on the extent of the symptoms and the age of the patient. A cheilotomy is performed when bony extensions have formed at the metatarsophalangeal joint of the big toe.
Since they can often be very painful, they are removed by means of the operation. This procedure can be performed when the joint is still largely intact. The big toe can then be moved again freely and without pain.
In addition, if the disease continues to progress and worsens, a further operation can be considered, in which the joint can ultimately be replaced by a prosthesis. However, this is only possible if the bone has not been manipulated too much beforehand. In another procedure, osteotomy, the metatarsal bone is shortened.This relieves the joint surfaces and prevents the progression of a hallux rigidus.
Another surgical treatment is the stiffening (arthrodesis) of the metatarsophalangeal joint of the big toe. It is used on young and active people. The joint is stiffened in such a way that the big toe is positioned inwards and facing upwards.
This enables a painless rolling motion and safe loading. Furthermore, an endoprosthetic replacement is also possible for this joint. The joint of the big toe is replaced by a metal prosthesis similar to a knee joint prosthesis.
The prerequisite for this surgical procedure is an intact and stable bone. Nevertheless, this operation is controversial. The big toe is exposed to a great deal of stress. Doctors therefore bear in mind that a prosthesis loosens after a short time and can lead to subsequent problems.
