pathology: hallux rigidus

yogabook / pathologie / hallux rigidus

hallux rigidus / metatarsophalangeal joint stiffness

Definition of

Progressive osteoarthritis of the 1st metatarsophalangeal joint (big toe), often occurring together with or as a result of hallux valgus. Mobility is restricted and painful, especially when rolling over the big toe when walking/running. At 7:1, the incidence is significantly lower than that of hallux valgus. Hallux rigidus rarely occurs on both sides. Depending on the progression, conservative treatment may not be sufficient. Synovitis can occur as part of the arthritic process, and the joint space can also be completely closed so that the joint ossifies.

ICD M20.2

Cause

  1. unknown
  2. Hallux valgus
  3. familial disposition: poor cartilage substance
  4. Overload
  5. Microtraumas
  6. traumatic, due to fracture, complication after foot surgery
  7. Secondary, e.g. with gout, RA, paresis or foot deformities such as flat foot, kinked foot, hindfoot valgus
  8. Secondary as a complication after foot surgery

Predisposing

  1. Long feet, long big toe
  2. Overweight
  3. inadequate footwear
  4. Foot malpositions
  5. Metabolic and growth disorders

Diagnosis

  1. i.a. clinical
  2. Typical arthrosisnarrowing of the joint space on X-ray

Symptoms

  1. Pain in the 1st metatarsophalangeal joint
  2. progressive stiffening of the joint
  3. Possibly osteophytes on the os metatarsale I
  4. Signs of inflammation
  5. Rubbing noises, crepitations
  6. Avoidance behavior, altered gait pattern

Complications

  1. hallux limitus (completely stiffened joint)
  2. Changing the gait pattern to avoid pain with all possible consequences
  3. Disorders of the musculoskeletal system, especially in the knee and hip joints, but also further proximally
  4. Chronic pain

Therapy

  1. Symptomatic: analgesics, anti-inflammatory drugs, also by local infiltration
  2. Protection
  3. PT
  4. Balneotherapy, electrotherapy, hydrotherapy
  5. Bunion roller, roll-off aid, insoles, adapted footwear
  6. Physical: electrotherapy, hydrotherapy, balneotherapy (baths: with radon, sulphur)
  7. Infiltration of local anesthetics if necessary
  8. Cheilectomy (removal of osteophytes) if necessary, osteotomy if necessary, arthrodesis (surgical stiffening) if necessary
  9. Surgical intervention if necessary