Arthritis of the big toe, known as hallux rigidus, is a degenerative condition affecting the big toe. The condition is characterised by increasing stiffness and pain, making walking and daily activities difficult. As the most frequent location of osteoarthritis of the foot, it often affects adults between the ages of 30 and 60, compromising their quality of life.
Anatomy
The metatarsophalangeal (MTP) joint of the big toe plays a crucial role in human locomotion, supporting up to 120% of the body's weight, and dysfunction compromises mobility and independence. The MTP is formed by the junction of the metatarsal and the proximal phalanx, the ends of which are covered in articular cartilage to allow fluid movement. Two small sesamoid bones located beneath this joint play a key role in the distribution of forces and the flexibility of the foot. When this cartilage wears away, bone friction leads to pain and stiffness, the hallmarks of osteoarthritis.
Symptoms of hallux rigidus
The symptoms of hallux rigidus vary depending on the severity of the condition. Common signs include:
- Pain in the big toe joint, particularly when walking or doing physical activities.
- Stiffness and reduced mobility of the big toe.
- Swelling and inflammation around the joint.
- Development of osteophytes, which can cause visible deformity and additional pain. These growths can also impede the movement of the big toe by creating a mechanical conflict, particularly in dorsal flexion.
Causes of Hallux Rigidus
Hallux rigidus can result from a number of factors:
Trauma: Past injuries to the joint can damage the cartilage, leading to osteoarthritis.
Wear and tear: Repeated use and pressure on the joint, especially in athletes or people with intense physical activity.
Anatomical factors: Particular foot morphology can increase the risk of developing this condition.
Genetic: A family predisposition may also play a role.
Risk factors
Some factors increase the likelihood of developing hallux rigidus:
Age: The risk increases with age, especially after the age of 50.
Physical activity: Activities that put excessive pressure on the big toe, such as dancing or running.
Inappropriate footwear: Wearing narrow or high-heeled shoes can aggravate symptoms.
Medical conditions: Inflammatory diseases, such as gout or rheumatoid arthritis, can also contribute to osteoarthritis.
Treating Hallux Rigidus
The treatment of hallux rigidus depends on the severity of the condition and may include conservative or surgical methods. Conservative treatments are often the first to be considered.
Conservative treatment of hallux rigidus
Conservative treatments for hallux rigidus include several approaches.
Medication: Non-steroidal anti-inflammatory drugs are frequently prescribed to reduce pain and inflammation. They can be administered orally or topically.
Orthoses: The use of orthopaedic insoles or adapted footwear can relieve pressure on the joint.
Physical therapy: Specific exercises to improve mobility and strengthen the muscles around the foot joint.
Corticosteroid injections: Used temporarily and cautiously to reduce inflammation and pain.
Surgical treatment of hallux rigidus
If conservative treatments fail to relieve pain and improve mobility, surgery may be considered.
Cheilectomy is a procedure commonly performed on patients with mild to moderate osteoarthritis. It involves removing the osteophytes and part of the bone of the big toe to increase the joint's range of movement.
For more severe cases, arthrodesis, or joint fusion, may be recommended. This procedure involves fusing the bones of the big toe joint using screws or plates, thereby eliminating pain but also limiting mobility.
Progression and Possible Complications
Without proper treatment, hallux rigidus can lead to a complete loss of mobility in the big toe joint. The stiffness and pain can become permanent, affecting quality of life. In addition, the progression of osteoarthritis can lead to visible deformities of the foot, such as hallux valgus. Chronic pain can become constant and disabling, limiting the person's ability to lead an active life.
Post-operative complications can include infections, problems with healing and, in the case of arthrodesis, the risk of the fused bones not fusing together, sometimes necessitating further surgery.
Preventing hallux rigidus
It is possible to prevent or slow the progression of hallux rigidus by adopting certain measures:
Wearing appropriate footwear: comfortable with good support and a wide toe box to avoid pressure on the joint.
Maintain a healthy weight: Reduce the pressure on your feet.
Avoid high-risk activities: Limit activities that put excessive strain on the big toe.
Strengthening exercises: Incorporate strengthening and flexibility exercises to maintain joint health.
When should you contact the Doctor?
In the event of persistent pain, swelling or the development of visible foot deformities, a consultation is recommended. Particular attention should be paid to the first signs of pain and stiffness in the big toe in order to obtain an early diagnosis.
Care at Hôpital de La Tour
The diagnosis of hallux rigidus relies on imaging tests, particularly standard X-rays of the foot, to assess the extent of osteoarthritis, the presence of osteophytes and the reduction in joint space. In some cases, additional examinations such as an MRI or CT scan may be required to obtain a more detailed view of the joint structures and surrounding tissues.
Hôpital de La Tour offers comprehensive, multidisciplinary care, with specialists in orthopaedics, sports medicine and physiotherapy on hand to provide an accurate diagnosis and personalised treatment.
Conclusion
Hallux rigidus is a disabling condition that can greatly affect quality of life. Appropriate management, ranging from conservative treatments to surgical interventions, can offer significant relief and improve foot function. Hôpital de La Tour, with its modern facilities and skilled staff, is ideally placed to provide high-quality care for those suffering from this condition.
FAQ on hallux rigidus
1. What is hallux rigidus?
Hallux rigidus is a form of osteoarthritis that affects the big toe joint, causing stiffness and pain.
2. What are the first symptoms of hallux rigidus?
Symptoms include pain in the big toe joint, stiffness and reduced mobility.
3. What causes hallux rigidus?
Causes may include past trauma, excessive wear, anatomical factors and genetic predisposition.
4. What conservative treatments are available for hallux rigidus?
Treatments include anti-inflammatory medication, orthotics, physical therapy and corticosteroid injections.
5. When should surgery be considered for hallux rigidus?
Surgery is considered when conservative treatments fail to relieve pain and improve mobility.
6. What is the difference between cheilectomy and arthrodesis?
Cheilectomy involves removing osteophytes to improve mobility, whereas arthrodesis fuses the joint to eliminate pain.
7. How can hallux rigidus be prevented?
Wearing appropriate footwear, maintaining a healthy weight and avoiding risky activities can help prevent the condition.