The medical term hallux rigidus refers to a painful restriction of movement of the big toe. Doctors also speak of hallux limitus. The disease is based on increasing wear and tear of the joint, which eventually leads to complete arthrosis of the metatarsophalangeal joint of the big toe. Known causes are, for example, injuries, foot malpositions or metabolic diseases. If orthopaedic insoles and special shoes can help at the beginning of the problem, surgery is the treatment of choice later on. A specialist for foot surgery is now the right contact person for you.
When it comes to your feet, you are in particularly competent hands with foot surgeon Dr Tonio Gottlieb. The experienced doctor, who specialises in foot health, focuses on the whole person and their body statics in every treatment. Dr. Gottlieb has been researching foot diseases for many years, his therapies are of top international quality and are scientifically up to date. See Dr. Gottlieb's expertise for yourself and make an appointment for an examination.
What exactly is hallux rigidus?
Hallux rigidus is an arthrosis of the metatarsophalangeal joint of the big toe that develops due to increasing wear and tear. The cartilage on the joint surfaces wears down more and more over the course of a lifetime. In extreme cases, for example in the case of chronic incorrect loading, the entire cartilage can be destroyed. Affected patients then sometimes also experience severe to very severe pain and suffer from restricted movement of the metatarsophalangeal joint of the big toe. Statistically, men are affected more often than women.
Do you have constant pain in one of your big toes when walking or even in a resting position? Dr. Gottlieb will examine you carefully, make a diagnosis and advise you individually and comprehensively on all conservative as well as surgical treatment options.
How does hallux rigidus develop?
Medical experts have identified various factors that contribute to joint wear and tear and can thus also be involved in the development of hallux rigidus. The examples listed here may be factors that increase the risk of hallux rigidus:
- Foot deformities such as a flatfoot or a flat foot with instabilities in the inner metatarsal/ tarsal bone transition or even further towards the body.
- Long big toe
- uncompensated varus deformities of the foot (O-position, joint axis is bent outwards)
- Surgery on the metatarsophalangeal joint of the big toe (especially rearrangements of the metatarsal bones)
- Injuries or inflammations of the metatarsophalangeal joint of the big toe
- Metabolic disorders such as gout
- Malpositions due to paralysis symptoms
Many patients are diagnosed with hallux rigidus between the ages of 30 and 50. Depending on the severity and risk factors, it may be advisable to consult a foot specialist earlier.
How does hallux rigidus manifest itself and how can it develop?
Joint arthrosis is characterised by an increasing narrowing of the joint space. Increased wear and tear of the joint or increasing cartilage damage are the reason for this process. Inflammation of the joint occurs. The patient notices joint swelling, suffers pain when moving and later also in a resting position. If the joint space closes completely, the joint stiffens.
The course of hallux rigidus can be very individual.
- At first, patients usually only feel pain when passively bending the affected big toe up or down. Swelling of the joint due to inflammation may occur.
- As the disease progresses, it is possible that the mobility of the joint will slowly decrease. The joint surface may already be widened. It is possible that bone outgrowths are visible in the X-ray image and the joint space is already narrowed.
- As the condition progresses, movement of the joint may cause noises. This can be accompanied by cysts (fluid-filled blisters), bone outgrowths and a severely narrowed joint space. The pain then usually increases and mobility is often significantly limited.
- If the joint space can no longer be seen and movement in the joint is no longer possible, it can also happen that free joint bodies become wedged in the joint space and additionally block movements.
Do you suspect that you are developing hallux rigidus? Don't wait too long and make an appointment with Dr. Gottlieb. The earlier he makes the diagnosis, the more comprehensively the foot specialist can help you.
What symptoms can occur with hallux rigidus?
In most patients, only one metatarsophalangeal joint is affected by arthritis to a greater extent: The big toe swells and hurts when the affected person stretches it upwards. Some patients even hear an unpleasant noise when cartilage and bone rub against each other. Because rolling the forefoot hurts, sufferers often avoid this movement, preferring to place the diseased foot with the outer edge on or rolling over the outer edge. The painful result of this behaviour can be thick calluses on the outer edge of the foot. Bony outgrowths often form on the upper side of the joint, which can cause pressure pain on the back of the foot. If so-called joint bodies become detached and enter the joint space, the joint becomes blocked. As the disease progresses, the entire metatarsophalangeal joint of the big toe stiffens. Eventually, movement is no longer possible.
Where exactly does the pain occur with hallux rigidus?
The pain occurs on the bunion of the foot and in the big toe. If the patient tries to avoid this pain by adopting a protective posture, painful calluses can form on the outer edge of the foot.
Can hallux rigidus cause pain at rest?
Yes, pain is possible in an advanced stage even in a resting position. Typical for osteoarthritis are morning start-up pain and pain at rest at night.
When should hallux rigidus be treated by surgery?
Hallux rigidus is caused by wear and tear and therefore does not usually get better. If orthopaedic inserts and physical measures do not help, surgery is the method of choice. If it is performed early, the surgeon has the goal and also the possibility of preserving the joint function.
Dr Tonio Gottlieb recommends:
"Please seek the advice of a foot expert at an early stage. Then there is a chance to preserve the valuable movement function of the ankle.”
What is the procedure for a hallux rigidus operation?
Hallux surgery can be performed as an outpatient or inpatient procedure. There are various anaesthetic procedures available. In a personal consultation with Dr. Gottlieb, you decide together which is the best way for you.
What surgical techniques are used?
The surgical treatment of hallux rigidus is basically a routine procedure for Dr. Gottlieb. Depending on the diagnosis, Dr. Gottlieb will advise you individually and recommend the surgical technique that promises the best result.
In a consultation, Dr. Gottlieb will present all the surgical methods that are possible for you and will address your situation very precisely and specifically.
Dr Tonio Gottlieb recommends:
"Hallux rigidus surgery is now a common operation that can provide great relief. Nevertheless, a foot surgeon must take into account the specific indication of each patient to achieve the best possible result."
How long does the swelling last after the surgery?
It is completely normal for the operated foot to swell for several days to weeks after the operation. Dr. Gottlieb and his team recommend consistent elevation, possibly accompanied by lymphatic drainage. Then you will be fit for action again as soon as possible.
How is the aftercare following a hallux rigidus surgery?
After the operation you will wear a bandage shoe for about six weeks. Dr. Gottlieb will monitor the wound closely and familiarise you with the use of a splint. You are usually allowed to put weight on the foot early on. After about 14 days, the surgeon removes the stitches and you start physiotherapy. After four weeks, you can wear compression stockings to prevent swelling, and after six weeks, many patients wear normal, foot-friendly shoes again. If necessary, you use a medical shoe insert.
How long is sick leave after hallux rigidus surgery?
How long you cannot work after the operation depends on the respective procedure, the course of your healing and ultimately also your profession. Sick leave can vary from less than two weeks to up to 10 weeks.
Who pays the costs for hallux rigidus surgery?
If the operation is medically necessary, both statutory and private health insurance companies cover the costs.
How can hallux rigidus be treated without surgery?
If the arthrosis of the joint is not yet far advanced, the therapy can initially be conservative. The focus here is always on relieving pain and maintaining joint function.
Treating hallux rigidus without surgery: what forms of treatment are available?
Foot specialists use orthopaedic aids and physical therapy methods to treat hallux rigidus:
- a stiffened shoe sole under the bunion of the foot
- Orthopaedic insoles to relieve the affected toe
As a foot surgeon and specialist in his field, Dr Tonio Gottlieb is familiar with both surgical and conservative treatment methods for hallux rigidus. After a thorough examination and a personal consultation, the doctor will recommend your individual therapy plan.
How can you prevent hallux rigidus?
Although there is no 100 percent protection against the condition, you can try to prevent hallux rigidus by wearing healthy footwear and treating foot malpositions early on.