What Is stiff big toe ( Hallux rigidus)

The stiff big toe is a big toe that loses its normal joint mobility , first as a defense against pain, then due to a real mechanical limitation, due to the arthritic degeneration of the metatarsophalangeal joint.

Sometimes it can also be associated with valgus of the big toe (lateral deviation of the finger), but not for this confused with this pathology.The rigid big toe affects about 2% of the population with a clear prevalence of men over women, between 30 and 60 years of age.

What are the causes of the big toe?

The causes of the big toe can be manifold: from some metabolic systemic diseases (gout), inflammatory and autoimmuninataria ( rheumatoid arthritis and similar), to post-traumatic diseases with joint and micro -traumatic lesions in case of particular activities carried out by the patient (e.g. sports activities such as football, ballet, climbing, etc.).

However, as regards the latter, there is an anatomical conformation of the foot that predisposes to this pathology. It is a foot in which the length of the internal metatarsals (first, second, third) is excessive compared to the lateral metatarsals and therefore it is on these that the weight of the body weighs most. Not all athletes are, in fact, subject to this pathology.

What are the symptoms of the big toe?

The symptoms materialize in a pain in walking due to the reduced mobility of the big toe in extension, as happens in the “detachment” phase of the walk. In women, it is impossible to wear a shoe with a heel, even of a small size, and the tendency is to shift the weight of the body on the outer edge of the foot with frequent appearance of tendonitis of the peroneal or bursitis and redness of the fifth metatarsal.

The metatarsophalangeal joint undergoes a cartilage degeneration that can further aggravate (worsening) with progressive and parallel global enlargement of the joint itself, due to the formation of bony protrusions on the entire joint (osteophytes).

This occurs with the subcutaneous protrusion of the newly formed bone, which causes conflict and rubbing inside the shoe, painful redness, sometimes similar to the more well-known hallux valgus bursitis. Furthermore, with the passage of time, osteophytes determine a real mechanical limitation of the extension of the big toe on the metatarsus which aggravates the limitation of pain (analgesic).

The diagnosis

The diagnosis of rigid big toe is essentially clinical (specialist examination). It is based on the observation of joint deformity, bursitis, the finding of pain to the movement of the big toe. It will be necessary to distinguish this pathology from a hallux simply valgus, with conservation instead of the articular surfaces since the treatment will be different. To support the diagnosis, an X-ray of the foot will still be required .

The treatment

The treatment of the rigid big toe will be reserved for cases (the majority) in which this pathology is accompanied by pain (in fact there are patients in whom the severity of osteoarthritis is not correlated by an equally severe pain symptomatology).

Initially, the treatment must be aimed at reducing pain with the use of appropriate orthotic means : insoles, orthotics, suitable footwear, etc.

When these measures are no longer sufficient, surgical treatment is necessary. The intervention consists in the complete joint reconstruction of the metatarsophalangeal joint, by means of a real cartilage replacement (arthroplasty) .

This can be done with or without implantation of prosthetic material and similar devices used as spacers. The technique of reconstruction through articular interposition of autologous (own) tissue is easier and more physiological , in order to create, in place of ulcerated cartilage, a “Pad” of painless sliding of the big toe on his metatarsal. It is a matter of proceeding with the complete removal of the degenerated cartilage and the subsequent covering of the bone thus stripped, with excess capsule-synovial material.

Afterwards, the reconstruction of the ligaments and the repositioning of the big toe on the metatarsus with a secondary correction of the possible concomitant valgus. In the first 20 days after the operation, it will be necessary to keep the forefoot out of load and the gait with support, therefore, limited to the heel.

by Abdullah Sam
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