Therapy of hallux rigidus

In the treatment of hallux rigidus, a distinction is made between conservative and surgical therapy.

The conservative therapy

If an underlying disease, e.g. gout, is the cause of arthrosis, it should be treated first of all. Initially and in early stages of arthrosis, the mobility in the metatarsophalangeal joint of the big toe can be improved or maintained for a certain time by independent manual therapy with traction and displacement of the distal phalanx (demonstration by the physiotherapist). Rigid insoles, e.g. made of metal, made to measure are therefore required here.

Likewise, a ball roller under the (front) shoe can provide relief so that the rolling motion is kept away from the metatarsophalangeal joint of the big toe. The sole of the shoe itself must be stiffened at the same time. Alternatively, a Rigidus spring insert can be prescribed.

Natural remedies, especially the devil’s claw, should be mentioned here. Devil’s claw can be used alone for mild pain and for stronger pain to support the existing therapy. The Devil’s Claw is intended to reduce the symptoms of metatarsophalangeal joint arthritis of the big toe.

The therapy of a hallux rigidus can be supported by homeopathic medication. Various homeopathic medicines can help to alleviate the symptoms of osteoarthritis. Hyaluronic acid is a natural component of cartilage, which is particularly responsible for its elastic properties.

Depending on the degree of arthrosis, an injection of hyaluronic acid into the metatarsophalangeal joint of the big toe can improve the pain and movement situation. Insoles are used in various ways in the therapy of hallux rigidus. On the one hand, they are used as part of conservative therapy.

The aim is usually to minimize the strain on the foot or to reduce the pain. Especially for runners, the insoles can reduce problems occurring during training. In general, the insoles aim to prevent further wear and tear of the joint in the early stages.

This requires special insoles, for example with a carbon sole. These reduce the stress on the metatarsophalangeal joint of the big toe by means of a stiff sole and special padding in the area of the ball of the foot. There are also special Hallux Rigidus shoes where the insoles are already firmly integrated into the shoe.

Even a very wide shoe at the front, which allows the toes plenty of room to move, can reduce the load on the metatarsophalangeal joint. Insoles are also usually used as a supplement during splinting therapy. However, these are usually soft bedding insoles which are intended to reduce the load on the adjacent toe joints.

As a rule, the insole therapy must be supplemented by pain therapy and physiotherapy as part of conservative treatment. As a rule, the insoles can help well to delay surgical treatment. Due to the reduced stress on the affected joint, the occurrence of the inflammatory reaction is also prevented or at least reduced.

This not only results in less pain, but also reduces wear and tear on the cartilage. However, surgery is often necessary in the long term. As with all medical insoles, it is important that the insole or shoe is fitted exactly.

However, the insoles do not only serve to reduce the problems in the area of the big toe. The adjacent joints, such as the knee or hip joint, are also spared by improving the axial position. On the other hand, insoles are also prescribed after an operation to compensate for a changed foot position, often they are only used on the foot that has not been operated on.

In addition to improving the axial position and foot posture, insoles on the operated foot lead to a reduction in pain after the operation. The other foot usually receives an insole to harmonize the axes of both feet again. A splint in Hallux rigidus initially has the effect of immobilization.

This reduces the pain and limits the inflammatory reaction. By removing the stimulus that would occur through movement of the joint, the progression of the disease is slowed down. However, the splint or plastering of the foot is only one measure for acute therapy.It can be used well to heal an acute inflammation of the joint.

This type of immobilization can also be used after an operation. Depending on the surgical procedure, the lower leg may also be included. The splint protects the ball of the foot and improves foot posture, similar to an insole.

In principle, the splint is also suitable for everyday movement, but it is rather difficult to wear in shoes. Accordingly, the use of insoles or orthopedic shoes is recommended for long-term therapy. In the initial stages, it may help to wear the splint only indoors and for limited periods of time to improve symptoms. One disadvantage of the splint compared to insoles, however, is that it is not custom-fit. The splint can therefore stabilize the big toe and relieve the ball area, but a splint cannot have the other positive effects on other joints and the axial position.