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Hallux Rigidus

Hallux Rigidus (stiff toe)

Arthrosis (wearing away of the cartlilage) in the large toe phalangeal joint has several causes – damage to the joint, disturbance to blood circulation in the bone, or a hereditary condition. Arthrosis can also result from improper shoes (high heels). Initially, there is a restriction of the push-off movement of the large toe. After months or years, pain occurs. Sometimes one may feel a palpable hardening of the large toe joint, which can lead to pains in the shoe.

In the early stages, conservative treatments are preferred:

  • Wearing appropriate shoes
  • Cold treatments (cryotherapy)
  • Medications to relieve the inflammation (salves, pills)
  • Physical therapy
  • Technical orthopedic measures (butterfly rolls)

If the treatment possibilities noted above do not relieve the symptoms, an operation becomes necessary.

The following alternatives are available:

Operations to maintain the joint
Suspicious bone growths on the extension side are cleared away. Inflamed joint membrane and free-floating bodies are removed from the joint. The extension third of the head of the middle foot is removed diagonally. The surface that is cut extends to the transition area between destroyed and intact joint surfaces. In this way improved mobility in the joint is achieved and pains are thus relieved (see the illustration). This standard procedure (cheilectomy) is simple to perform, and the symptoms improve immediately after the operation.

Follow-up treatment
Full weight-bearing is possible immediately after the operation. In walking, one can push off from the toes normally. The patient begins movement exercises as soon as one day after the operation. Within 2 to 3 weeks, normal shoes can again be worn.

Operations to resection the joint
If the joint arthrosis is quite advanced, re-sectioning procedures are to be considered. In younger patients who require a stable foot in their occupation and in sports, operations are used to prevent rubbing and recurring arthroses. In this case the arthrodesis (stiffening) of the large toe phalangeal joint is possible. In older patients with end-stage arthrosis who do not have great demands for foot functioning, resection arthroplasty is the treatment of choice.

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