 A
painful and insidious condition of big toes that can lead to
significant limitations in an athlete’s ability to perform and bend
the
toe.
Arthritis is often described as a wearing out or erosion of the
cartilage between the
joints. With increased motion within the joints, there's a
gradual increase in the amount of erosion, causing greater damage
within the joint.
This disorder can be very troubling and even disabling, since
the big toe is used whenever we walk, stoop down, climb up, or even
stand. Many patients confuse hallux rigidus with a bunion, which
affects the same joint, but they are very different conditions
requiring different treatment.
This condition also occurs when the golf players apply
excessive pressure to the big toe during the golf swing. Typically it will
occur at the end of the follow through and will only happen on the dominant
foot. In other words, if the golfer is right-handed, the right hallux will
be the involved toe. This can cause a jamming of the toe into the top of the
shoebox. With repetition, the subungual tissue will be injured and blood
will form under the nail plate. This can cause pain due to the pressure the
blood exerts on the
nail bed.
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It begins with limited toe motion, being referred to as “hallux
limitus.” But as the problem advances, the toe’s range of motion
gradually decreases until it potentially reaches the end stage of “rigidus,”
in which the big toe becomes
stiff, or what is sometimes called a “frozen joint.”
Cause:
Movement of the big toe joint occurs typically in an up and down
plane only (dorsiflexion and plantarflexion). The normal
dorsiflexion is approximately 75 degrees and plantarflexion is 25
degrees.
Limited motion can be a result of :
- Heredity
- Faulty function (biomechanics)- imbalance in your foot
structure and foot function
- Any traumatic incident, something as simple as jamming your
toe, which may have occurred and caused localized inflammation
within the joint.
Most people with flat feet or low arches are more susceptible to
developing hallux rigidus deformity.
Symptoms:
 Pain
about the first first metatarsophalangeal joint ( MTPJ) is the
presenting symptom of patients who have hallux rigidus. The patient
may or may not be aware of the limitation of joint motion. Given the
limitation of dorsiflexion, patients may complain of increased
difficulty with activities that require greater dorsiflexion
demands, such as walking up an incline, squatting or
running.
-
Pain and stiffness in the joint at the base of the big toe
during use (walking, standing, bending, etc.)
-
Difficulty with certain activities (running, squatting)
-
Swelling and inflammation around the joint.
-
Pain and stiffness aggravated by cold, damp weather
As the disorder progresses, other symptoms including pain while
at rest, limping or the inability to wear certain shoes (result of
bone spur) will become more noticeable. The patient might complain
dull pain in the
hip , knee, or
lower Back due to changes in walk. Limping might occur in severe
cases.
Diagnosis:
The most common symptoms include pain and swelling within the
joint. If diagnosed at early stage, you stand a better chance to
remain comfortable and active for many years. The diagnosis of
hallux rigidus is made after a thorough examination of your foot by
an orthopedic surgeon which may also include diagnostic x-rays.
Treatment:
Early non-surgical treatment for mild cases of Hallux rigidus
may include:
-
Prescription foot orthotics
-
Shoe modifications (to take the pressure of the toe and/or
facilitate walking)- Shoes with a large toe box put less
pressure on your toe. Stiff or rocker-bottom soles may also be
recommended.
-
Medications- Oral nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, may be recommended to reduce pain and
inflammation.
-
Injection therapy (corticosteroids to reduce inflammation
and pain), and/or
-
Physical therapy- Ultrasound therapy or other physical
therapy modalities may be undertaken to provide temporary
relief.
-
Exercise: Regular athletes should be encouraged to perform
passive range of
motion exercises with an emphasis on dorsiflexion. The
athlete should perform these exercises two or three times a day
by grasping the base of the proximal phalanx of the great toe
and maximally dorsiflexing the joint to tolerance at least 20 to
30 times.
As the symptoms subside the athlete can return to activity, you
can protect the hallux from excessive dorsiflexion with taping.
Apply the taping in a figure-eight loop around the proximal phalanx
and attach it to the plantar surface of the foot.
Surgical Treatment
The surgical treatment for hallux rigidus is determined by the
extent of the arthritis and deformity. For the more minor type of
hallux rigidus, shaving the bump of the bone on top of the
metatarsal is sufficient (a cheilectomy). As the stiffening of the
big toe joint increases a cheilectomy is not sufficient and an
additional bone cut may needed on the big toe itself, (an osteotomy
of the phalanx).
As the arthritis increases, the ability of an osteotomy or
cheilectomy to correct the problem, maintain motion, and prevent the
arthritis from worsening is very limited. For these patients, either
a fusion of the big toe (an arthrodesis) or removal of bone from the
joint (an arthroplasty) is performed.
Ref:
http://www.podiatrytoday.com/
http://www.mdmercy.com/
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