Big toe joint arthrosis

introduction

The Big toe joint arthrosis is also known as "Hallux rigidus“And is a disease of the forefoot. In this clinical picture, there is arthrosis in the metatarsophalangeal joint of the big toe, i.e. a so-called arthritis Joint wear, in front. After this hallux valgus the metatarsophalangeal joint of the big toe is the second most common disease of the foot. It manifests itself above all from the age of 40 and is more typical for women.

causes

How arthrosis of the metatarsophalangeal joint of the big toe occurs has not yet been conclusively clarified. However, certain factors are discussed as triggers of hallux rigidus. These include, among other things, wearing the wrong footwear, the presence of one shortened Achilles tendon, inflammatory diseases, an enormous elongated first ray the toe or its High stand and a Improper loading. The last mentioned cause can be caused by a flattened arch of the foot be conditional.
However, osteoarthritis of the metatarsophalangeal joint of the big toe can also develop due to a hereditary predisposition.The smallest injuries in the area of ​​the metatarsophalangeal joint of the big toe can also provoke osteoarthritis at this point. Then there are others Foot deformities like hallux valgus or Metabolic disorders, for example the Gout diseasethat increase the likelihood of developing metatarsophalangeal joint arthritis of the big toe.

Symptoms

The two main symptoms of osteoarthritis of the big toe are the Pain and the Joint stiffness. The pain arises on the one hand because there are bony changes in the area of ​​the metatarsophalangeal joint of the big toe, so-called small bumps or protrusions on the dorsal side of the foot, i.e. on the back of the foot. These protruding bones are also called "osteophytes". They look like small bumps over the joint and can cause pain by irritating the surrounding tissue. The irritation in turn arises from the fact that previously suitable footwear suddenly becomes too tight and the protruding bones become pressure or friction points.

With the pain go symptoms like Swelling, redness in a correspondingly irritated place and overheating. The pain, of course, increases with movement, as this makes the irritation worse. Therefore, it is not uncommon for affected patients to change the gait pattern. By a Relieving posture and a limping gait, patients try to prevent the painful rolling movement in the metatarsophalangeal joint of the big toe. As a compensation, they therefore also roll over the outer edge of the foot. The tendency is associated with an internal rotation of the foot. Depending on the severity of the metatarsophalangeal joint arthrosis of the big toe, even just standing can cause pain.

Of the Joint wear brings the second main symptom Joint stiffness with himself. Due to osteoarthritis, i.e. the joint wear and tear, the metatarsophalangeal joint of the big toe is less and less mobile, so that ultimately the restriction of movement has progressed to such an extent that one can speak of a stiff joint. Problems in the knee and hip area can result as the end of the causal chain of pain, incorrect loading, changed gait pattern and relieving posture.

Please also read: Hallux rigidus symptoms

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Diagnosis

To diagnose a metatarsophalangeal joint arthrosis of the big toe, both a detailed Anamnesis interview as well as the clinical examination important. When the metatarsophalangeal joint of the big toe is inspected, small knobs, the protruding bones, can be seen on the dorsal and medial side of the metatarsal bone. In addition, a limited dorsiflexion, i.e. the stretching of the toes towards the back of the foot, can be tested in affected patients. To secure the diagnosis, the roentgen be consulted. A picture of the foot is taken in 2 levels under load. There are one on the x-ray Joint narrowing as a result of cartilage wear and a changed bone pattern in the sense of extensions or small spurs.

Learn more about the X-ray signs of osteoarthritis

treatment

The choice of therapy depends on the severity and intensity of the metatarsophalangeal joint arthrosis of the big toe and the patient's level of activity. The main goal is to prevent the progression of osteoarthritis and to alleviate the symptoms Freedom from pain and improved mobility to guarantee.

Conservative treatment follows different approaches: On the one hand, it is recommended to wear suitable shoe material and insoles. On the other hand, physiotherapeutic and physical therapy can help with osteoarthritis of the base toe. The physical therapy approach works primarily with heat and electricity in order to stimulate self-healing processes. Medicinal applications can also primarily alleviate an existing, inflammatory irritation. Nowadays, injection therapy is also expected to be successful.

Learn more about therapy methods at: Therapy of hallux rigidus and Treatment with a shoe spring for hallux rigidus

insoles

Wearing insoles as an orthopedic aid is considered to be proven in the treatment of osteoarthritis of the big toe. In addition to good footwear, the insoles aim to give the foot a better and individual shape and to counteract a relieving posture with a consequent change in gait pattern. Of the Pain on the moveA major symptom of metatarsophalangeal joint arthritis of the big toe can be alleviated by wearing such insoles at an early stage of the disease. The principle behind it is, the forefoot through a special shoe sole processing more stability to give. Through a kind of stiffening of the shoe sole material in the area of ​​the metatarsophalangeal joint of the big toe, this is relieved and hard impacts or the rolling movement when walking is dampened.
The material is usually carbon. The insert thus has a preventive effect against a poor gait pattern or a faulty rolling process. Nowadays there is both the so-called “Hallux rigidus spring” and the “Hallux rigidus roll”. The main purpose of the spring is to facilitate the rolling movement. Therefore it is processed in the shoe sole under the metatarsophalangeal joint of the big toe. In most cases it consists of metallic or plastic-containing material and is worked into the shoe sole in such a way that it cannot be seen from the outside. The role is also in the shoe sole and should above all have a stiffening effect. It is a kind of recess in the sole in the area of ​​the end link, i.e. at the metatarsophalangeal joint of the big toe.

surgery

At a certain stage, conservative therapy is no longer sufficient to treat metacarpal joint arthrosis of the big toe. Nowadays, however, there is various operational options to care for such a disease. A so-called Cheilectomy performed, a classic surgical procedure in the treatment of osteoarthritis. This removes the protruding bones, i.e. the osteophytes, which, among other things, cause pain in the metatarsophalangeal joint of the big toe. So the goal of the cheilectomy is this Pain reduction. The pain caused by the rolling movement and pressure on the ball of the foot should be relieved by such an intervention.
But also improving mobility is a goal of cheilectomy. During the operation, the disturbing pieces of bone as well as excessive mucous membrane and cartilage thickening are removed. All disruptive factors are thus eliminated, so that the joint space is ultimately completely cleared.

However, the most common method used for the surgical treatment of osteoarthritis of the big toe is the Arthrodesis. Arthrodesis is also called stiffening designated. Both operations can be found under General –or Regional anesthesia can be carried out in both inpatient and outpatient stays.

stiffening

The surgical procedure is particularly useful for young and physically active patients with a severe form of disease Arthrodesis to use. Another indication is when the Rolling pain represents the main symptom. Arthrodesis is a widely used surgical method, so that in addition to the metatarsophalangeal joint of the big toe, it is also used to treat joints on the shoulder, hand or foot. The stiffening ultimately eliminates the joint mobility in the metatarsophalangeal joint of the big toe. However, this restriction is not a problem as the other joints can compensate for the loss of movement and the pain is eliminated at the same time.

The stiffener can either be via the Opening of the joint capsule take place, i.e. intra-articularly or without opening, i.e. extra-articularly. The worn material in the joint is then removed. The joint can then be fixed or stiffened with the aid of various osteosynthesis systems. So-called Kirschner wires, for example, are suitable for this.

After this procedure, the stiffened joint must receive appropriate follow-up care. Further treatment with insoles and the right, individually adapted footwear is a prerequisite. The healing time takes about 6-8 weeks. So long should the Foot immobilized and not be burdened. I.e. the heels should tend to be more heavily loaded than the forefoot area. Sometimes the foot is then bandaged in a protective cast.

Please also read our topic: Splint for hallux rigidus

forecast

Nowadays, arthrosis of the metatarsophalangeal joint of the big toe can be treated very well with the various therapeutic approaches, so that the Chances of recovery through both conservative and surgical treatment very good stand. If left untreated, the situation in the metatarsophalangeal joint worsens more and more, but the course can be positively influenced by treatment.

A therapy that has not yet been established due to a lack of success rates is the insertion of an endoprosthesis into the metatarsophalangeal joint of the big toe. However, this type of treatment is currently being discussed more and more, as it offers the clear advantage of avoiding joint stiffening. By inserting the Endoprosthesis the main symptom of pain can be alleviated while maintaining mobility. This variant is becoming more and more attractive, especially for women, as they can continue to wear high heels without any problems. However, if the patient only moves the joint in moderation and does not plan any vigorous sporting activities, that would still be the case Arthrodesis makes more sense.