Hallux rigidus is classified according to the severity of the condition:

1. Early stage (Grade I):
   • Mild pain under load and minimal movement restriction.
2. Intermediate stage (Grade II):
   • Pain during daily activities, limited mobility, and initial bone spurs (osteophytes).
3. Advanced stage (Grade III):
   • Significant movement restriction, constant pain, and pronounced joint stiffness.
4. End stage (Grade IV):
   • Complete joint stiffness and severe impairment of mobility.

The causes of hallux rigidus are diverse and include:

• Mechanical overload:
  • Repeated stress from sports or occupation leads to microtrauma in the metatarsophalangeal joint of the big toe.
• Anatomical misalignments:
  • Foot deformities such as flatfoot or high arch increase the load on the metatarsophalangeal joint of the big toe.
• Injuries:
  • Previous injuries such as fractures or dislocations can promote osteoarthritis in the joint.
• Genetic predisposition:
  • Familial clustering of osteoarthritis suggests a genetic predisposition.
• Inflammatory diseases:
  • Diseases such as rheumatoid arthritis or gout promote degenerative changes.

The symptoms often develop insidiously and intensify as the disease progresses:

- Pain:

- Initially only under stress, later also at rest.

- Movement restriction:

- Especially the dorsal extension (movement of the toe upwards) is restricted, making rolling off difficult.

- Swelling and redness:

- Inflammatory reactions can lead to visible changes.

- Bone growths:

- Osteophytes are palpable as hard protrusions and cause pressure pain in shoes.

- Gait changes:

- Pain often leads to limping, which promotes discomfort in other joints.

The diagnosis is based on medical history, clinical examination, and imaging techniques:

• Medical History:
  • Collection of medical history, description of pain, and possible risk factors.
• Clinical Examination:
  • Assessment of mobility, tenderness, and visible changes.
• Imaging Techniques:
  • X-ray: Visualization of joint space narrowing, osteophytes, and subchondral sclerosis.
  • MRI: Detailed visualization of cartilage damage and soft tissues.

Conservative Therapy

In early stages, non-operative treatment is often sufficient:

• Shoe Modifications:
  • Shoes with stiff soles or rolling aids relieve the joint.
• Orthopedic Insoles:
  • Special insoles improve pressure distribution and reduce pain.
• Physiotherapy:
  • Exercises to maintain mobility and strengthen foot muscles.
• Pain Therapy:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen to relieve pain and inflammation.
  • Injections with cortisone, hyaluron, or PRP.
• Shock Wave Therapy:
  • Mechanical stimuli promote healing and reduce pain.

Surgical Therapy

In advanced stages, surgical intervention may be necessary:

• Cheilectomy:
  • Removal of bone spurs to improve mobility.
• Arthrodesis:
  • Joint fusion to reduce pain in severely advanced osteoarthritis.
• Endoprosthesis:
  • Joint replacement with an artificial prosthesis to restore function.

To prevent hallux rigidus, it is recommended:

1. Suitable footwear: Shoes with enough space for the toes and good cushioning.
2. Regular exercise: Promoting joint mobility through targeted exercises.
3. Avoiding overstrain: Protecting the joint during sports or professional activities.
4. Early treatment: Immediate therapy at the first signs of pain or movement restrictions.
5. Weight management: Reducing excess weight to relieve the joints.