Hallux Rigidus

In a personal consultation, we will ask you about your complaints and their progression. This is followed by a thorough physical examination of the foot. We pay attention to:

• Mobility of the metatarsophalangeal joint of the big toe, in particular the restriction of upward extension. The mobility is compared with the healthy opposite side.
• Pain points and their localisation, especially when pressure is applied to the upper part of the joint.
• Palpable bone spurs (osteophytes) around the joint.
• Changes in the gait pattern.
• Condition of the cartilage using special tests such as the "grinding test", in which pain can be triggered by a grinding movement if there is a central cartilage defect.

An X-ray of the foot under load usually confirms the diagnosis. We can recognise the following changes on the X-ray:

• Narrowing of the joint space due to cartilage degradation.
• Presence of osteophytes (bone spurs) at the edges of the joint.
• Signs of overload on the bone close to the joint in the form of sclerosis lines (hardening of the bone) and cysts (fluid inclusions).

In some cases, further imaging procedures such as magnetic resonance imaging (MRI) may be useful to assess the condition of the cartilage and soft tissue more precisely.

The radiological findings help us to classify the severity of hallux rigidus into different stages (I-IV). This categorisation is important for choosing the appropriate treatment.

• Anti-inflammatory drugs (NSAIDs) in tablet form can reduce pain and inflammation.
• Painkillers can be taken if necessary.

Mobilisation exercises involving traction on the toe can help to stretch the joint capsule and make the joint more flexible. Stretching exercises of the calf muscles can also be useful for athletes with hallux rigidus.

Manual therapy and strengthening exercises can also be part of the treatment.

This plays a decisive role. Recommended:

• Shoes with stiff soles and roll-off aids to relieve the metatarsophalangeal joint when walking and avoid excessive painful movements. A cradle sole can also be helpful.
• Sufficient space in the shoe, especially in the toe area, to avoid pressure points on the bone attachments.
• If necessary, the manufacture or modification of orthopaedic shoes.

Special insoles, especially with a bunion roller or a stiffener under the big toe, can relieve the metatarsophalangeal joint and reduce the strain. Supporting the longitudinal arch of the foot can also be useful.

Avoid activities that cause pain and, if necessary, reduce weight to relieve the pressure on the feet.

Cheilectomy can help with mild to moderate osteoarthritis (grade I and II) and circumscribed pressure symptoms caused by bone spurs.

In this procedure, the troublesome bone attachments (osteophytes) around the joint are removed and the part of the joint with the worn cartilage layer is also removed.

The aim is to improve mobility and reduce pain. In some cases, this procedure can be minimally invasive. Cheilectomy is often combined with an osteotomy (bone rearrangement) of the big toe (Moberg osteotomy) to further improve upward mobility.

If the first ray is too long, a shortening osteotomy can also be performed (Youngswick osteotomy or oblique osteotomy).

The chances of success after a cheilectomy are generally good, with more than 80% of patients being satisfied or very satisfied.

In advanced osteoarthritis (grade III and IV), fusion of the metatarsophalangeal joint is the most reliable method of permanently eliminating pain in the joint.

The residual cartilage is removed and the neighbouring bones are fused together to create a pain-free but immobile joint.

Functional restrictions when walking are usually minimal. Even the ability to play sports is usually retained. The only restrictions are in the choice of shoes, although heels up to approx. 3 cm high can usually still be worn.

The chances of success after arthrodesis are very high. Even with a stiffened big toe joint, patients can usually walk well and resume many types of sport.

In individual, selected cases, an artificial joint can also be used as an alternative to fusion, especially in advanced stages of osteoarthritis with good residual mobility, if there are individual reasons against arthrodesis.

There are various types of prostheses, such as elastic surface replacement prostheses made of cartilage-like plastic.

However, due to higher complication rates, joint replacement is only considered in exceptional cases.

We attach great importance to state-of-the-art surgical techniques and implants, taking into account the biomechanics of the entire foot.

• Elevation of the foot for the first two weeks to allow the wound to heal.
• Mobilisation of the metatarsophalangeal joint in a therapeutic shoe until the wound has healed.
• Ideally, start physiotherapy after two weeks to train mobility.
• Gradual change to comfortable everyday shoes (preferably running or hiking shoes) may be possible after 2 weeks.

• Inpatient stay of two to three days.
• Elevation of the foot for the first two weeks to improve wound healing.
• Mobilisation in physiotherapy takes place in a therapeutic shoe that protects the arthrodesis. Partial weight-bearing may be necessary at first.
• After six weeks, a follow-up check is carried out with a clinical examination and X-ray.
• Depending on the progress of healing, the foot must continue to be immobilised on a hard sole.
• After 6 weeks, you can switch to a comfortable everyday shoe with a stiffer sole and ideally a roll-off support.

• In the first few weeks after the operation, the foot should be protected and weight-bearing should be increased slowly.
• Crutches can be provided for support.
• It is normal for the foot to swell, which will slowly subside over several months (approx. 1 month per decade of life). It may therefore be necessary to wear oversized replacement shoes for the first few months.
• Depending on the occupation and level of activity, it can take up to 3 months before most professional and everyday activities can be fully resumed. It usually takes around 1 year for the swelling to completely subside and normalise (final result).