Frequently asked questions − concerning hallux rigidus

What is a hallux rigidus?

Hallux rigidus is an increasing stiffening of the metatarso-phalangeal joint of the big toe, mostly accompanied by pain, due to the loss of cartilage in this joint (see Figure 1). This process is called arthritis (joint wear) and in principle, it can occur on every joint of the body.
The metatarso-phalangeal joint of the big toe is exposed to a particularly high pressure load when walking and the foot is unwound. In the course of the disease, a particularly compact development of painful bone growth occurs. This is caused by strong friction, which the joint surfaces are exposed to by the absence of cartilage layers. (See Figure 3). These bony growths are often felt or visible through the skin and cause repeated painful inflammation in the vicinity of the metatarso-phalangeal joint of the big toe.

Figure 1 shows the radiograph of a hallux rigidus. In this case, it is particularly noticeable that the joint gap is barely visible in the vicinity of the metatarso-phalangeal joint of the big toe (Figure 2). This leads to recurring inflammatory changes in the overly tight joint (marked in red in Figure 3).

Which courses of treatment are available for the treatment of hallux rigidus?

The problem of hallux rigidus can hardly be approached by a conservative approach to therapy. Even cartilage-building syringes or tablets rarely lead to an improvement. Therefore the hallux rigidus is usually operated on. Here, a distinction is made between three different possibilities:

1. A partial removal of the metatarso-phalangeal joint of the big toe, which leads to a significant shortening and a reduction in the active mobility of the big toe.

2. Stiffness of the metatarso-phalangeal joint of the big toe, resulting in the complete removal of mobility in the big toe, and a long period of rehabilitation and relief.

3. The use of an artificial metatarso-phalangeal joint of the big toe, which often leads to premature loosening. This is something which is associated with complicated interactions and can lead to a massive loss of bone substance.

Due to the disadvantages mentioned above associated with conventional methods, a gentle hallux rigidus operation has been developed which, in its effectiveness and technical principle, is very similar to our hallux valgus operation.

What is the principle behind the gentle operation method in the case of hallux rigidus?

The main cause which leads to the formation of a hallux rigidus, is too much compression in the metatarso-phalangeal joint of the big toe. Therefore, our gentle hallux rigidus operation aims at reducing this too high a pressure.
The 1st metatarsal bone is shortened slightly (see Figure 5). As a result, the joint gap widens by the corresponding distance so that the pressure and thus the friction in the metatarso-phalangeal joint of the big toe is significantly reduced. This way, the wear and tear in the joint is slowed significantly in its development and the pain is elimina-ted, without any stiffening or removal of the the metatarso-phalangeal joint of the big toe, or replacement by an artificial joint.

Figure 4 shows (in red) the bone growths on the joint that are removed as part of the operation on the joint. Furthermore, the bone cylinder, which is removed for shorten-ing the bone, is also shown in red.
Figure 5 shows the situation after the removal of bone growths on the joint, as well as the bone cylinder. The ends of the bone are joined together and stabilised with a titanium plate. The implant is removed again after 12 months under short anesthesia.

How is the post-operative treatment performed?

As in the case of the bunion operation, the legs of the patients can still be fully stressed on the day of the operation. This also apples to the hallux rigidus operation, even if both feet were operated on simultaneously. The use of crutches or special forefoot relief shoes is dispensed with. The stay in hospital is 3-4 days. The threads are removed after 14 days. The titanium plate used for the stabilization of the bone is removed 9-12 months after the operation. Treatment is performed on an outpatient basis under local anesthesia. Patients can then leave the clinic immediately and fully stress the treated foot.

More information on hallux valgus can be found in the section foot surgery.

It is self-evident that many questions remain unanswered.

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Gelenkzentrum Berlin

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