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Hallux rigidus or artrosis of the big toe - Surgery

What is Hallux Rigidus?

Hallux_rigidus

The name hallux rigidus comes from the Latin, in which hallux means ‘big toe’ and rigidus means that the toe becomes rigid or stiff. Hallux rigidus is actually a form of osteoarthritis (wear and tear of the cartilage in the MTP joint of the big toe). Just like osteoarthritis, hallux rigidus or MTP I osteoarthritis is a progressive condition, in which the mobility of the toe reduces over time. At first, mobility is somewhat limited, but as the problem progresses the mobility of the MTP joint is reduced until the toe is completely rigid.

The cause

Hereditary strain as a result of a foot type that is more inclined to develop this defect. Conditions such as rheumatoid arthritis or gout.

Complaints

Pain and stiffness in the big toe when walking or running. Swelling and inflammation around the MTP joint. The toe feels tired. Increasing pain, even when resting. Difficulty wearing normal footwear. Serious cases may cause the individual to limp.

Diagnosis

The quicker the condition is identified, the easier it is to treat. If you experience one of the symptoms described above it is recommended you contact your GP or specialist. Your foot will be examined by the GP or specialist, usually accompanied by an X-ray. In some cases biochemistry will also be used.

Treatment

Non-surgical treatment:

If the condition is identified early on, non-surgical treatment may be successful, to the extent that surgery can be avoided completely in some cases. Treatment options for a mild form of hallux rigidus could consist of:

  • Adapting a shoe insert with a rocker sole in the forefoot, so that the pressure on the big toe is relieved.
  • Adjusting the footwear, providing a sufficiently large toe box.
  • Medication: analgesics or non-steroidal anti-inflammatory drugs.
  • Injections: in extremely rare cases a corticosteroid infiltration may be administered, yet this is certainly not our preference.
  • Treatment of an underlying condition such as gout.

Surgical treatment:

In certain cases only a surgical procedure is able to eliminate the symptoms caused by hallux rigidus. Two major groups of surgical procedures are possible:

Joint-saving surgery:

This procedure involves cleaning up the joint (cheilectomy). The procedures are designed so that they preserve and restore the normal alignment and normal function of the joint and eliminate the pain.

Procedures in which the joint cannot be saved (these can be divided into arthrodesis or arthroplasty):

  • Arthrodesis involves the joint being immobilised in a certain position, which ensures the pain disappears completely and a normal gait can be preserved, subject to the pre-operative agreement with the surgeon that a certain heel height will not be exceeded.
  • A second option is to perform an arthroplasty. This involves replacing the joint with a prosthesis as in a hip or knee.

This procedure ensures the joint is painless, but with some degree of mobility compared with an arthrodesis.

This content was written by : Dr. Stijn MuermansDr. Mark van DijkDr. Jan Van Oost

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