|
Synonyms in further meaning
Hallux non extensus, Hallux limitus, arthrosis in the basic joint of the big toe, big toe arthrosis in the basic joint, stiffness in the joint of the big toe
Definition
Hallux rigidus (stiff big toe) is an attrition-dependent (degenerative) illness of the basic joint of the big toe (arthrosis). The results of this joint attrition (abrasion) are a limitation of movement the big toe and foot pain with stress. If Hallux rigidus is left untreated, it leads to a complete stiffening of the basic joint of the big toe. Sometimes, the preliminary stages of this illness are also designated as Hallux limitus (limited movement of the big toe).
Sexual distribution and frequency
Hallux rigidus affects primarily men. The primary (unknown cause of) Hallux rigidus occurs on one side. The illness occurs in all age groups and often begins in youth.
Symptoms
Through the joint abrasion of the big toe that depends on attrition, a painful movement limitation of the big toe joint arises. Especially the rolling of the forefoot when walking is painfully limited. In addition, endurance is significantly restricted for longer walking distances. In the onset phase of the illness, sufficient bending capability of the big toe is usually still retained at first (towards the sole). The extensor capability of the big toe that is significantly more important for the rolling procedure when walking (backwards toward the foot) becomes ever more limited, until the big toe finally becomes stiff in the most severe cases in a bent position in the basic joint. By overextending the final joint of the big toe, a minimal rolling capability is retained.
On the basis of the painful rolling action of the forefoot, the manner of walking is subsequently altered in an advanced stage of the illness. A protective manner is taken, partly limping protectively on the affected side. Rolling over the outer border of the foot has also been often observed when walking, sometimes even with a tendency to twist the entire foot inward, in order to “walk around” the pain. This can be recognized by the asymmetric wear of shoe soles from affected patients. The toe condition can no longer be demonstrated as pain-free; especially climbing stairs and walking up hills becomes tortuous.
Upon examining the foot, a thickened basic joint of the big toe is often observed. The joint is sensitive to pressure, partially reddened and overly warm. Mobility is limited by pain. Upon moving the basic joint, chafing can be detected, as an indication that the smoothing, frictionless joint cartilage has become worn and the bones are rubbing against each other. This is a phenomenon, which is encountered with many diseases of the joint that are caused by attrition (e.g. arthrosis of the knee, shoulder, hip etc.)
The X-ray image demonstrates modifications in the basic joint of the big toe, which were caused by attrition, including a reduction of the joint cleft (cartilage attrition), modifications of the bone delineation (whitish sclerosis) and typically significant creation of spurs that resemble rose thorns directly on the joint.
Causes
Arthrosis of the basic joint of the big toe develops gradually over many years. Normal athletic activities usually do not encourage the development of arthrosis. However, injuries can lead to damage of joint cartilage and thus to arthrosis. It is possible that the illness in most people can be attributed to inherently „inferior“ cartilage (primary Hallux valgus). Additional possible causes are deformities of the big toe basic joint, e.g. by Hallux valgus, defective position of the big toe (cartilage injury by chronic, asymmetric stress of the joint) and metabolic disturbances such as gout (cartilage injury by ureic acid crystals and inflammatory reactions). But an overload of the basic joint of the big toe can also encourage Hallux rigidus, without deformity, for example by a shortened 1st joint (shorter 1st metatarsal bone).
Therapy
Fundamentally, a conservative therapy is possible, but it is not successful in advanced cases. Usually, the clinical picture must be addressed in a surgical manner.
Conservative Therapy
Should a fundamental illness, e.g. gout disease, be the cause of the arthrosis, this must be treated first.
Initially and in early stages of arthrosis, mobility can be improved in the basic joint of the big toe by independent, manual-therapeutic exercises, by pulling and pushing on the final joint (demonstration by physical therapists); respectively, mobility can be retained for a certain time. (Please also refer to the recommended literature hereto, since the advance of the arthrosis can be beneficially influenced by you).
Shoe Provision
On the basis of painful movement limitation of the basic joint of the big toe, rolling of the forefoot is especially impeded. The goal of the shoe provision is therefore to relieve the basic joint of the big toe through suitable shoe modifications. Pertinent hereto are stiff inserts, e.g. custom-made from metal or carbon. By means of a ball roll under the (anterior) shoe, when walking stress will be removed from the basic joint of the big toe, because the rolling motion will be undertaken by the ball roll. Accompanying hereto, the sole of the shoe, itself, must be stiffened. Alternatively hereto, a „rigid-field insert“ can also be prescribed.
Natural Remedies
Natural remedies, especially devil’s claw (Phyteuma) for example, can help to diminish pain. The devil’s claw can be applied alone for slight pain and as a supplement to existing therapy for severe pain. The devil’s claw should diminish the symptoms of arthrosis of the basic joint of the big toe.
Operative Therapy
If conservative therapeutic procedures are insufficiently effective, surgical therapeutic procedures will be applied.
Different surgical procedures are available. The degree of severity of Hallux rigidus illness, accompanying maladies of the foot as well as the age and demands of the patient decide the therapeutic procedure.
Cheilectomy
Hereby the bone protuberance (rose thorn type of spur) on the backside of the foot on the first metatarsal head will be ablated and the joint edges will be made smooth. In addition, tendon adhesions will be separated. If insufficient stretching is possible thereafter, a re-positioning of the basic joint will be performed in order to enable a good rolling action.
Provision with Prosthesis
Under certain prerequisites, a biocompatible, artificial joint can be implanted. The worn out surface of the old joint must be removed hereby. By means of prosthesis of the basic joint of the big toe, good mobility of the big toe basic joint is achieved with good foot rolling. The problem is that such an artificial joint can become loosened, which requires subsequent operations. Unfortunately, the shelf-life and burden of these prostheses are limited. You can find more about this in our book ”The Optimal Therapy of Hallux rigidus” (see below)
Operation according to Keller-Brandes
It deals with a joint-removal procedure, with ablation of 1/3-2/3 of the basic joint of the big toe. This operation is only to be applied for older patients, since it does not consider the biomechanics of the foot and the big toe is shortened; it is regarded as cosmetically disturbing.
Arthrodesis (Stiffening) of the Basic Joint of the Big Toe
For younger, athletically active patients, a selective fusion (stiffening) of the big toe basic joint is recommended in a somewhat elevated (extended) toe position. After recuperation has been completed, a painless and powerful rolling movement is possible. The mobility in the big toe basic joint remains intact.
| 
