Hallux rigidus

Ricarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.

More about the experts All content is checked by medical journalists.

Hallux rigidus (Hallux limitus, Hallux flexus, Hallux non extensus) describes a painful restriction of movement of the big toe. The reason for this is usually that the joint wears out with age. Men are affected more frequently than women. In addition to pain relievers and orthopedic aids, treatment can also consist of hallux rigidus surgery. Read more about the causes, symptoms and therapy of Hallux rigidus here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. Q74M20

Hallux rigidus: description

Hallux rigidus is the second most common dysfunction of the big toe after hallux valgus. It usually arises from the fact that the joint wears out due to increased stress (osteoarthritis). The big toe (hallux) can then only be moved with pain and to a limited extent (limitus). If the disease progresses, the metatarsophalangeal joint of the big toe can also completely stiffen (hallux limitus).

Hallux rigidus often occurs in the elderly. Even if a little more men are affected, women usually have symptoms earlier because they often wear high heels.

Hallux rigidus: symptoms

Hallux rigidus usually only affects one foot. At first, the short muscles of the foot may twitch more often. The big toe shows a swelling and can only be moved upwards to a limited extent and with pain. Sometimes you can even hear pieces of cartilage and bone rubbing against each other (crepitation). The ball of the foot is also painful, which is why the patient does not roll the foot properly when walking. Instead, the foot is placed with the outer edge of the foot. The changed gait pattern can cause painful calluses to form on the outer edge of the foot. On the back of the foot, bony protrusions can form over the big toe, which are often tender on pressure.

Small joint bodies sometimes loosen as the disease progresses. If they get into the joint space, the joint can become blocked. If the hallux rigidus continues, the metatarsophalangeal joint of the big toe becomes increasingly stiff. After all, the big toe can then neither be moved up nor down.

Hallux rigidus: causes and risk factors

So far it is not clear why hallux rigidus develops. However, various factors are discussed that promote joint wear (osteoarthritis) in the big toe and thus promote this disease. These include:

Shoes that do not have the right foot shape
Foot shape: narrow, long feet, long big toe
Malpositions such as flat feet, foot tilted inward, malalignment after paralysis
Incorrect or excessive strain due to an abnormal gait pattern or excess weight
Trauma: Injuries, broken bones, inflammation, complications after foot surgery
Metabolism or growth disorders

In the course of osteoarthritis in the metatarsophalangeal joint, the joint space becomes narrower. The joint surfaces ossify and can become inflamed (synovitis). The partially swollen joint can only be moved with pain and to a limited extent. If the hallux rigidus continues, the joint space can be completely closed by remodeling processes. The joint is then completely stiffened.

Hallux rigidus: examinations and diagnosis

The doctor examines how flexible the metatarsophalangeal joint of the big toe is. Pain, swelling and rubbing noises from the bones and cartilage indicate hallux rigidus. He also assesses the callus formation on the foot and the gait pattern. In the advanced stages of the disease, there are partial bones on the back of the toe. Palpation is painful for the patient. An X-ray does not provide indications of hallux rigidus until very late. The doctor can then tell whether the joint space is narrowed and the joint surfaces are ossified.

Hallux rigidus: treatment

Depending on the stage of the disease, there are different options for treating hallux rigidus. First you try to relieve the pain. On the one hand pain medication and on the other hand aids that immobilize the foot help. Various physical treatment methods such as balneotherapy and electrotherapy are also used. In the long term, shoes with the right foot shape and special insoles help with Hallux rigidus. If these measures are not effective, hallux rigidus surgery can be considered.

Hallux rigidus: pain treatment

For severe pain, pain medication can be taken or applied to the joint as an ointment. Pain medication, which also inhibits inflammation and has a decongestant effect (anti-inflammatory drugs), is particularly suitable for this.

In addition, the so-called infiltration therapy can help with hallux rigidus against the pain. A local anesthetic and a cortisone preparation are injected into the painful area on the foot. The anesthetic relieves pain and the cortisone reduces inflammation. Because this treatment can easily lead to infections, it should definitely be carried out by an experienced doctor.

Treatment of pain makes it possible for some patients to perform the physiotherapeutic exercises that are indicated for hallux rigidus.

Hallux rigidus: immobilization

By immobilizing the metatarsophalangeal joint with a splint or a cast, you can relieve the joint and inhibit an inflammatory reaction. This usually also relieves the pain. However, this therapy is only used for a temporary period. As soon as the acute inflammation has subsided, other orthopedic aids such as hallux rigidus insoles are recommended.

Hallux rigidus: shoes, insoles and orthopedic aids

Suitable footwear is very important for hallux rigidus. The shoes should correspond to the individual foot shape. Otherwise the gait pattern can change, which favors hallux rigidus. The shoe sole can be stiffened under the forefoot. This can relieve the pain when rolling the foot and promote a normal gait pattern. There are also certain Hallux rigidus insoles. They are reinforced under the big toe so that they relieve the metatarsophalangeal joint and cushion shocks.

Hallux rigidus: physical therapy

In physical therapy, the body is specifically stimulated by physical measures (such as heat, electricity. This is supposed to stimulate the body's self-healing process and have a positive effect on the disease process. The following physical therapies are used in Hallux rigidus:

Balneotherapy: Sulfur baths are supposed to counteract inflammatory joint problems and signs of wear and tear. A so-called radon bath is supposed to relieve pain. The radioactive noble gas radon is used for this. This therapy can only be used for a limited time.
Electrotherapy: direct current or alternating current in different frequencies should influence the vessel size. The aim is to improve blood circulation in the treated area and relax the muscles. Overall, this should reduce the pain.
Hydrotherapy is the use of water. Foot baths, washes, wraps and cold-blooded hip baths can promote healing.

Hallux rigidus: surgery

If the non-surgical measures do not improve the symptoms sufficiently, hallux rigidus surgery may be necessary. Depending on the symptoms and the age of the person affected, a choice is made between various surgical interventions:

Cheilotomy: This operation is used for painful hallux rigidus with bony extensions on the dorsum of the foot in the area of the metatarsophalangeal joint, when the joint itself is still undamaged. The bony extensions are removed in the process. This should allow the big toe to be moved upwards again without pain. Cheilotomy offers the advantage that symptoms that recur later can still be treated with arthrodesis or resection arthroplasty.
Osteotomy: In this type of hallux rigidus operation, the metatarsal bone is shortened. In addition, the joint surfaces of the metatarsophalangeal joint of the big toe can be adjusted so that the big toe is pointing further down. This operation is intended to relieve the metatarsophalangeal joint of the big toe and prevent the hallux rigidus from progressing further.
Arthrodesis of the metatarsophalangeal joint of the big toe: This hallux rigidus operation is recommended for young and active people with hallux rigidus in whom the metatarsophalangeal joint of the big toe has already been destroyed. The joint is stiffened in a certain position. The big toe is pointed upwards and inwards. As a result, force can be transferred to the big toe when the foot rolls off without causing pain.
Resection arthroplasty: This is a surgical method for older and less active patients with advanced arthrosis of the metatarsophalangeal joint of the big toe. A piece of the lower big toe bone is removed. In addition, the surgeon forms a small flap from part of the joint capsule and fixes it in the joint space.
Endoprosthetic treatment: Similar to a knee joint prosthesis, part of the bone and the articular surface on the big toe is replaced by a metal prosthesis. The success of this hallux rigidus operation is controversial because the toe is stressed with great force when walking. This can loosen or even loosen the prosthesis.

Hallux rigidus: disease course and prognosis

Hallux rigidus does not resolve on its own, but usually progresses without treatment. With suitable treatment methods, however, one can alleviate the symptoms and positively influence the disease process. Good orthopedic care with Hallux rigidus insoles and suitable shoes is particularly useful here. There are also various surgical options for hallux rigidus.

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