Anatomy
The metatarsophalangeal joint (MTP-1) of the big toe is formed by the first metatarsal and the proximal phalanx of the big toe.
Cause of the problem
Stiffness in the metatarsophalangeal joint of the big toe (hallux rigidus) is a common condition in sports and is caused by irritation of the metatarsophalangeal joint, often after repeated previous major or minor trauma (e.g. football, handball, jumping, skiing). There may be bone formation (osteophytes) on the upper (dorsal) joint surface or inflammation with fluid formation in the joint.
This causes pain and reduced mobility if the big toe is bent upwards (extension), such as when walking. The normal extension to 70 degrees is often reduced to less than 30 degrees (compared to the opposite big toe).
Symptoms
Pain in the base joint of the big toe when walking. Worsens when the big toe bends upwards. Tenderness on the top and sides of the metatarsophalangeal joint of the big toe. Swelling of the metatarsophalangeal joint of the big toe can occasionally be seen.
Examination
Diagnosis is based on clinical examination, which may need to be supplemented with imaging. Ultrasound scans are best suited to see the first signs of wear and tear in the joint, including osteophytes, while X-rays can often only recognise wear and tear in more widespread cases.
The ultrasound scan can also detect increased fluid in the joint and blood vessel growth (Doppler activity). MRI scans are rarely indicated.
Treatment
Treatment primarily involves relief from pain-inducing activity with slowly increasing load within the pain threshold. Shoes with a stiff sole (possibly a rocker sole) are recommended. Treatment may be combined with arthritis medication (NSAIDs) or an injection of adrenal cortex hormone in the toe joint. Surgery can improve mobility in mild cases by removing the bone growth (osteophytes) on the upper side of the joint.
In more severe cases, an artificial joint (alloplasty) can be inserted or the joint can be stiffened (Koh D, et al. 2023). However, there is little evidence that normal arch support over the big toe is achieved with surgery.
Rehabilitation, specific:
Loading within the pain limit is allowed. Guidelines during rehabilitation are generally followed. Active and passive movement of the big toe within the pain threshold is advised to maintain mobility.
Bandage
Taping can be applied to support the base joint, which reduces pain with continued sports activity and walking, see taping. Rigid insoles can be tried.
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct or if there are complications:
- Arthritis disease in the joint
- Bone fracture
- Stress fracture in the femoral neck
- Fracture of the sesamoid bone under the toe
- Plantar plade syndrom
- Tendon synovitis
