Hallux rigidus

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What is hallux rigidus?

Hallux rigidus is an arthrosis in the metatarsophalangeal joint of the big toe that can lead to stiffening. The distinctions between hallux valgus (malposition of the big toe), hallux limitus (arthrosis with difficulties in the rolling movement) and hallux extensus (the big toe points upwards) are fluid. For example, a hallux valgus malposition can also develop into hallux rigidus. 

Hallux rigidus: Causes and risks factors

The reason some people develop hallux rigidus and others don't is not known in detail. Possible causes of arthrosis in the big toe are hereditary factors, injuries, inflammation, excessive strain and malposition. Usually, several influences play a role in the development of hallux rigidus.  

Possible risk factors for the development of hallux rigidus are:  

• Accidents, injuries 
• Hereditary disposition 
• Poorly fitting, tight footwear (e.g. pumps) 
• Foot deformities 
• Flattened longitudinal arch and heel buckling 
• Incorrect or excessive strain, for example, due to abnormal gait pattern or overweight 
• Traumas such as bone fractures and tissue injuries  
• Inflammation 
• Conditions such as rheumatism, gout, diabetes mellitus 

Can hallux rigidus be prevented?

The best way to prevent hallux rigidus is to minimise the risk factors: Wear suitable footwear, exercise regularly, but protect your feet from overload. Eat a healthy diet and get a medical examination and advice promptly if you have foot pain or malposition.  

Symptoms and signs of hallux rigidus

The most common symptom is pain in the metatasophalangeal joint during the rolling movement while walking. This often results in compromised posture. This leads to abnormal stresses on the feet, which can cause complaints spreading to the metata

If left untreated, pain, numbness and overheating can occur later on, even at rest. Arthrosis can cause episodes of swelling, redness and severe pain.  

Therapy and treatment: What can be done about arthrosis in the big toe?

In order to make the diagnosis, the first step is a thorough check of the patient’s medical history. The metatarsophalangeal joint of the big toe will also be manually examined and x-rayed. Often, changes in the joint space (narrowing due to abrasion of the cartilage) or bone spurs will already be visible.  

The aim of treatment of toe arthrosis is to prevent the progression of the condition, alleviate the symptoms and enable the patient to walk as painlessly as possible. A doctor will determine the therapy according to the stage of the condition. There are conservative, drug and surgical treatment measures available.  

Shoe foot orthotics and other conservative treatment measures for hallux rigidus 

If possible, it is advisable to start therapy with relieving shoe foot orthotics before the toe starts to become stiff. The hallux rigidus foot orthotics provides noticeable relief for the metatarsophalangeal joint of the big toe.

Operations for hallux rigidus

If conservative measures are not successful or the condition is too advanced, the orthopaedist may consider surgery.  

In severe arthrosis, the artificial surgical stiffening (arthrodesis) of the metatasophalangeal joint is currently the method of choice. The joining of the two bones contributes to freeing the patient from pain. The adjacent joints and an orthopaedic roller on the shoe sole compensate for the associated loss of movement.  

Bone spurs (osteophytes) are removed in the case of mild hallux rigidus. This procedure is called cheilectomy. In severe forms, this can be combined with a corrective osteotomy (also called a repositioning osteotomy): the bone is surgically cut (osteotomised) to restore the normal anatomy of the bone, joint or extremity and to relieve joint parts.¹ 

What doctor treats hallux rigidus?

The first point of contact for hallux rigidus is your GP. They can refer you to orthopaedic surgeons who specialise in foot deformities. 

 The medi Rigidus f-tec, for example, has a rigidus spring insert that provides a leverage effect over the painful joint. The properties of glass fibre ensure that the energy used is returned - controlled by the spring – when the foot rolls when walking. This provides additional cushioning for the foot and supports it with every step.

For people who have hallux complaints and wear medical compression stockings, there are special versions, such as those with a hallux relief zone.