Foot pain is immediately perceived as restricting movement. If the normal rolling process over the big toe is not possible without pain for a long time, arthrosis such as hallux rigidus can be the cause. This disease does not only affect older people.
What is hallux rigidus?
Osteoarthritis of the metatarsophalangeal joint of the big toe is called hallux rigidus. The disease initially occurs with pain and a clearly visible expansion of the circumference of the ball of the foot and can gradually lead to stiffening of the joint.
The restricted movement of the big toe is characteristic. Hallux rigidus usually only appears on one foot and occurs regardless of age, but more often in men than in women. Depending on the severity of the disease, four stages are distinguished in hallux rigidus, which are represented by an increase in pain and restricted movement.
A cause for the occurrence of hallux rigidus can usually not be found. A hereditary predisposition as well as minor injuries to the metatarsophalangeal joint can be a possible cause. Incorrect loading or overloading can also play a role.
Hallux rigidus often occurs in patients with gout because the longitudinal arch of the foot flattens out and the foot buckles inwards as a result. This leads to incorrect loading of the metatarsophalangeal joint of the big toe and thus to hallux rigidus.
Symptoms, Ailments & Signs
The main symptom of hallux rigidus is pain in the area of the big toe. These are usually permanent, but can become worse under particular stress and through movement. The big toe can only be moved upwards with severe pain. In the case of an advanced hallux rigidus, the joint can also be completely blocked.
When the joint moves, you may hear pieces of cartilage and bone rubbing together. Swelling and sometimes redness can usually be noticed. Especially with the onset of hallux rigidus, the short foot muscles can twitch visibly. Bony outgrowths often form on the back of the foot above the big toe.
These are usually very sensitive to pressure. When stepping with the affected foot, pain occurs. For this reason, the foot position is also changing. The foot does not unroll properly when walking. Those affected touch down with the outer edge of the foot, which can also cause calluses in the affected areas.
After some time, the joint becomes increasingly stiff. In addition, patients with hallux rigidus often perceive a lack of space in the shoe. The symptoms increase at low temperatures. Hallux rigidus usually affects only one foot.
Diagnosis & History
The doctor can diagnose hallux rigidus based on an examination and the patient’s medical history. X-rays are taken to determine the severity of the disease. In hallux rigidus of the first degree, the ability to move the big toe is reduced by 20 to 50 percent and pain is sometimes felt when the foot is subjected to stress.
In the 2nd degree, the ability to move is reduced to up to 75 percent with severe pain. The joint space is shown reduced on the X-ray image. The 3rd degree is characterized by a further restriction of movement, whereby the big toe can no longer be moved upwards. Patients suffer from constant pain, which worsens when walking. The joint space is almost non-existent.
In hallux rigidus of the 4th degree, there is a complete inability to move the metacarpophalangeal joint. The pain is very severe and increases with the load on the foot. In the worst form of hallux ridigus, the x-ray no longer shows any existing joint space.
In most cases, the hallux rigidus causes severe pain in the foot. This pain mainly leads to restricted movement. Normal running, walking and standing is usually no longer possible. Likewise, sporting activities are no longer feasible for the person concerned. The restricted movement and the permanent pain often lead to depression and other psychological complaints.
Under certain circumstances, irritability or aggressiveness can develop in the patient. The hallux rigidus puts an incorrect load on the foot, so that the symptoms usually only get worse if no treatment is carried out. Due to the disease, the patient is severely restricted in his everyday life and can no longer carry out various activities without further ado. This leads to a severe reduction in the quality of life.
The treatment of hallux rigidus does not lead to further complications. It takes place with the help of medication or surgical interventions and in most cases leads to a positive course of the disease. In some cases, part of the big toe may need to be removed. Life expectancy is not affected by hallux rigidus.
When should you go to the doctor?
Since hallux rigidus causes severe pain, an examination and treatment by a doctor is essential. This can prevent further complications. As a rule, the doctor should be consulted for hallux rigidus if the disease causes severe restrictions on the big toe. The toe hurts, and the pain itself can spread to the entire foot.
Hallux rigidus also causes incorrect loading of the foot, so that the affected person often has to adopt a bad posture or a relieving posture. Limping or limping can also indicate the disease. If the symptoms cannot be explained by an accident and occur over a longer period of time, then a visit to a doctor is definitely recommended.
Hallux rigidus can be diagnosed and treated by an orthopedist or general practitioner. As a rule, the complaints are well alleviated with the help of insoles. There are no particular complications.
Treatment & Therapy
Depending on the stage of hallux rigidus, there are various treatment options. In the case of arthroses of the 1st and 2nd degree, conservative treatments are in the foreground. They are designed to relieve pain and swelling and reduce stress on the joint. These include anti-inflammatory drugs and insoles for shoes.
Physical therapy exercises can help improve joint mobility. However, this does not reverse the joint wear. In addition, patients should avoid wearing tight shoes. Footwear with plenty of room for the toes and the ball of the foot are also suitable for orthopedic insoles. Up to a second-degree hallux rigidus, the bony prominences can also be surgically removed. The purpose of the cheilectomy is to restore mobility.
The selection of the right surgical procedure depends on the age and activity level of the patient. Arthrodesis is often the surgery of choice in younger patients. Here the base joint is stiffened. Pain-free rolling is then possible again because mobility in the toe end joint is retained. A Keller-Brandes operation is primarily performed on older patients, as part of the phalanx of the big toe is removed, thereby shortening it.
A joint prosthesis can also be used for hallux rigidus. However, the durability and resilience of these prostheses are limited, so that replacement operations are necessary.
Outlook & Forecast
As long as the stiffening of the big toe is in the early stages, there are good chances of recovery. Then you don’t have to have an operation. There are many conventional treatments to choose from. These include taking body building materials, anti-inflammatory drugs, orthopedic shoe inserts and physiotherapy.
The situation is different when the disease progresses rapidly. Then standing and walking is only possible with pain. Long distances can no longer be covered at all. Then only an operation can help. This is associated with similar risks as with other surgeries.
Those affected can also help themselves to ensure that the hallux rigidus disease does not worsen. Especially in the early phase, they are responsible for themselves. This begins, for example, with the regular wearing of suitable shoes. In wide and soft footwear, the toes find enough space and pain does not even arise.
Consistent exercise units on the big toe also prevent stiffening. Physiotherapists introduce the sick to the training. This and other advice from professionals and doctors must be observed. This avoids an operation whose positive outcome is not always certain.
There is no effective prevention for hallux rigidus. Incorrect loading and overloading should be avoided by wearing suitable footwear. This is especially true for runners, but also for everyone who is exposed to a lot of strain on their feet at work, because hallux rigidus can occur at any age.
In most cases, the patient with hallux rigidus has very few follow-up measures available. In the case of this disease, an early diagnosis is very important in the first place, so that further complications or a worsening of the symptoms can be avoided. It cannot heal on its own, so the person affected should consult a doctor as soon as the first signs and symptoms of this disease appear.
In most cases of hallux rigidus, insoles are used for the shoes to relieve the symptoms. You can also take medications to relieve inflammation. When taking it, it is important to ensure that the dosage is correct and that it is taken regularly. In some cases, however, an operation is necessary to relieve the symptoms permanently.
The affected person should rest after the procedure and refrain from strenuous or physical activities. If the disease does not appear until old age, a prosthesis can be used to combat the symptoms. As a rule, this disease does not have a negative effect on the life expectancy of the person affected.
You can do that yourself
Since the pain associated with an existing hallux rigidus is often very pronounced, pain treatment is of great importance in therapy. In addition to painkillers, the person concerned can use over-the-counter pain ointments. Foot baths, wraps and cold-blooded sitz baths are also recommended.
In addition, it is extremely important to relieve the affected joint in order to inhibit the inflammatory reactions. Physical exertion and sport should therefore be avoided at all costs. Instead, the foot should be elevated and, if necessary, cooled with cold packs to promote swelling and relieve pain.
Well-fitting footwear is also very important for hallux rigidus. The shoes must not be too tight. Instead, they should offer enough space for the toes and balls of the feet to avoid pressure points. At the same time, sufficient stability must be guaranteed at all times.
In many cases it is also necessary to wear special insoles. The following applies here: If the doctor prescribes insoles, they must be worn regularly – i.e. daily – in order to increase the chances of successful treatment. If physiotherapy is required, the patient must actively participate in this as well, so that the situation improves quickly.