What is Hallux Rigidus?
Hallux rigidus is a condition that causes pain and limited movement in the joint where the big toe meets the metatarsal bone, due to cartilage damage. This joint is called the metatarsophalangeal (MTP) joint, and it is the most common joint affected by osteoarthritis in the foot.
What Causes Hallux Rigidus?
The cause of joint damage in the big toe’s MTP joint is unknown in most patients. The most common cause is genetic predisposition. It occurs twice as often in women as in men. In most cases, the disease affects only one side, but in 20% of patients, both big toes are affected.
Other causes of hallux rigidus include:
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Trauma to the joint, such as fractures or dislocations.
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Overuse in athletes, such as soccer players, long-distance runners, and ballet dancers.
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Previous infection in the joint.
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Rheumatic diseases, such as gout and rheumatoid arthritis.
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Foot deformities and weight-bearing abnormalities, such as flat feet.
What are the Symptoms of Hallux Rigidus?
Patients with hallux rigidus experience pain and limited movement in the big toe’s MTP joint. Pain increases with activities such as walking and running and wearing high heels or tight shoes. Swelling may develop on the top of the joint, which is caused by new bone growth resulting from cartilage damage.
How is Hallux Rigidus Diagnosed?
After listening to the patient’s detailed history, the foot is examined thoroughly. Other conditions that could cause pain in the big toe (hallux valgus, gout, etc.) are considered. A diagnosis of hallux rigidus is usually made based on the results of standing foot x-rays.
How is Hallux Rigidus Treated?
Treatment begins with non-surgical methods, such as avoiding activities that cause pain, wearing wide and soft shoes that do not squeeze the big toe. Additionally, pain-relieving medications and ice applications, which can be used after consulting your doctor, can alleviate your pain. It is not possible to reverse the joint cartilage damage caused by hallux rigidus. Surgery is the only treatment option in advanced stages of the disease.
What Surgeries are Performed for Hallux Rigidus Treatment?
There are two different types of surgeries for hallux rigidus.
Cheilectomy Surgery: This surgery is performed when the big toe joint cartilage damage is not very advanced, especially when patients have difficulty wearing shoes due to bone protrusion and when these protrusions restrict big toe movement. The bone protrusions are shaved off, and damaged cartilage structures in the joint are cleaned.
Fusion Surgery for the Big Toe Joint: If the joint cartilage damage is severe, the surgery to be performed is the fusion or immobilization of the big toe joint, also called the first metatarsophalangeal joint arthrodesis.
How is Hallux Rigidus Fusion Surgery Performed?
This surgery, which lasts about 45-50 minutes, can be performed under general or regional anesthesia. A one-day hospital stay may be required. If the surgery is performed early in the morning, the patient can go home in the evening.
The surgery is performed using an open technique, entering from the top of the big toe. Damaged cartilage structures in the joint are cleaned, and the joint is usually fixed at a special angle using two screws or sometimes plates and screws. If the fixation angle is ideal, the patient can continue their daily life and sports activities without any restrictions after surgery.
What is the Post-Operative Process for Hallux Rigidus Fusion Surgery?
After the surgery, the patient is allowed to walk using crutches and wearing a special shoe. At this stage, it is important to bear weight on the heel and not on the big toe.
First 2 weeks:
Within 10-14 days after the surgery, your surgical wound will heal. During this time, it is recommended to move with crutches only for essential needs, such as using the bathroom and eating. Resting and keeping your foot elevated will prevent swelling. Moving your ankle is important, especially for preventing blood clots.
2-6 weeks:
The surgical site will be completely healed. As the pain decreases while bearing weight, you will start putting more weight on your foot. The swelling will gradually decrease during this period. At the end of the 6th week, an x-ray will be taken. If the targeted bone fusion is achieved, the crutches can be discontinued.
