Hallux Rigidus Surgery

What Is Hallux Rigidus? (A Clear Definition and General Overview)

Hallux Rigidus literally means “stiff big toe” and refers to a condition that develops as a result of osteoarthritis (degenerative arthritis) of the metatarsophalangeal (MTP) joint at the base of the big toe. This osteoarthritis causes wear of the joint cartilage, leading to stiffness, pain, and limited range of motion in the joint. In particular, upward movement of the big toe (dorsiflexion) becomes restricted, which makes it difficult for the toe to lift off the ground during the push-off phase of walking. Hallux Rigidus is a different condition from Hallux Valgus (bunion); in Hallux Valgus the big toe deviates toward the other toes, whereas in Hallux Rigidus the underlying problem is osteoarthritis of the joint and the resulting stiffness. However, the two conditions can sometimes occur together. As Hallux Rigidus progresses, it can also cause bone spurs (osteophytes) to form around the joint, resulting in a swelling on the top of the joint known as a “dorsal bunion.”

Causes and Risk Factors of Hallux Rigidus

Several factors can play a role in the development of Hallux Rigidus:

• Osteoarthritis: The most common cause. It develops as a result of natural wear and tear of the joint cartilage with age.
• Trauma and Injuries: Past blows, fractures, or sprains to the big toe joint (such as the athletic injury known as “turf toe”) can set the stage for Hallux Rigidus in later years.
• Foot Structure and Biomechanics: Certain foot structural features (such as a long first metatarsal bone) or abnormal foot mechanics (such as excessive pronation) can increase the load on the MTP joint, raising the risk of osteoarthritis.
• Genetic Predisposition: The condition is more common in people with a family history of Hallux Rigidus.
• Inflammatory Diseases: Systemic inflammatory conditions such as rheumatoid arthritis or gout can also affect the MTP joint and cause Hallux Rigidus, although this is less common.
• Overuse: The risk may be higher in people who frequently perform activities requiring rising onto the toes (such as dance or certain sports).

Symptoms and Clinical Findings of Hallux Rigidus

The symptoms of Hallux Rigidus usually begin gradually and worsen over time. The most common clinical findings are as follows:

• Pain: Pain in the big toe joint that increases especially during activities such as walking, running, or rising onto the toes. Pain may also worsen after activity or in cold weather.
• Stiffness and Limited Motion: Noticeable difficulty and restriction in moving the big toe joint, especially when bending the toe upward (dorsiflexion).
• Swelling and Inflammation: Swelling around the joint and occasional redness or warmth.
• Bone Spurs (Osteophytes): Bone spurs that form on the top or sides of the joint (dorsal bunion). These spurs can cause friction and pain inside the shoe.
• Difficulty Walking: Because the big toe cannot bend, a tendency to walk on the outer edge of the foot may develop.
• Activity Limitation: Difficulty with activities such as squatting, climbing stairs, or rising onto the toes due to pain and stiffness.

Diagnostic Methods for Hallux Rigidus

Hallux Rigidus is diagnosed based on the patient’s complaints, a detailed foot examination, and imaging methods. Prof. Dr. Murat Bozkurt carries out the diagnostic process meticulously at his clinic in Ankara:

• Medical History: Information is gathered about the onset, duration, and severity of the patient’s complaints, factors that worsen or relieve the pain, past trauma, family history, and general health status.
• Physical Examination:
  
  • Observation: Swelling, redness, bone spurs, and possible deformities in the big toe joint are assessed.
  • Palpation: Tenderness and painful points are identified by pressing on the joint.
  • Range of Motion Assessment: The active and passive range of motion of the MTP joint is carefully measured, especially dorsiflexion (upward bending) and plantar flexion (downward bending). The degree of stiffness is determined.
  • Gait Analysis: The patient’s walking pattern is examined to observe weight-bearing deficits and pain-avoidance mechanisms.
• Imaging Methods:
  
  • X-ray: Weight-bearing foot X-rays are the gold standard for diagnosing Hallux Rigidus. They clearly show joint space narrowing, cartilage loss, osteophyte (bone spur) formation, and the stage of arthritis (mild, moderate, severe). These findings are critical for treatment planning and, in particular, for the surgical decision.

Rarely, additional imaging methods such as MRI or CT may be used to assess other issues within the joint.

Treatment Options for Hallux Rigidus: When Is Surgery Necessary?

The goal of treating Hallux Rigidus is to reduce pain, increase (or preserve) joint motion, and allow the patient to comfortably return to daily life activities. Treatment is planned according to the stage of the disease, the patient’s age, activity level, and the severity of their complaints.

• Conservative (Non-Surgical) Treatment: Usually preferred as the first step, this approach can help control symptoms in mild to moderate cases of Hallux Rigidus:

  • Shoe Modifications: Wide-toed shoes that do not press on the toes. Stiff-soled or rocker-bottom shoes can reduce the load and motion at the big toe joint during walking, easing pain.
  • Insoles and Orthotics: Custom-made stiff insoles or carbon fiber plates can reduce pain by limiting motion at the big toe joint.
  • Medication: Pain relievers and anti-inflammatory drugs (NSAIDs) can be used to reduce pain and swelling.
  • Intra-Articular Injections: Corticosteroid injections can temporarily reduce inflammation and pain in the joint. Hyaluronic acid injections may also be tried in some patients.
  • Physical Therapy: Gentle exercises, stretching, and manual therapy techniques aimed at preserving joint range of motion may be applied.
  • Activity Modification: Avoiding or reducing activities that trigger pain (such as running or jumping).

• Indications for Surgical Treatment: Surgical treatment is considered in patients who do not achieve adequate relief with conservative methods, who have severe pain, whose daily life activities are significantly limited, and who show radiologically advanced findings of Hallux Rigidus.

Surgical Treatment Methods for Hallux Rigidus: Prof. Dr. Murat Bozkurt’s Approach

Different surgical techniques can be applied in Hallux Rigidus surgery depending on the stage of the disease, the patient’s age, activity expectations, and bone quality. In Ankara, Prof. Dr. Murat Bozkurt determines the most suitable surgical method for each patient and performs treatment using modern techniques.

• Cheilectomy (Bone Shaving Surgery): Generally preferred in the early and moderate stages of the disease, when the joint cartilage is largely preserved. In this procedure, the bone spurs (osteophytes) that form on the top and sides of the big toe MTP joint are surgically removed (shaved). The goal is to eliminate mechanical impingement in the joint, increasing upward motion of the big toe (dorsiflexion) and reducing pain. Microfracture or cartilage restoration procedures may occasionally be added.

  • Prof. Dr. Murat Bozkurt’s Approach: With appropriate patient selection, he regards cheilectomy as an effective method that aims to relieve pain and improve function while preserving joint motion.

• Osteotomy (Bone Realignment Surgery): In this technique, the first metatarsal bone or the proximal phalanx of the big toe is cut and repositioned. For example, in the technique known as the Moberg osteotomy, a wedge is removed from the base of the proximal phalanx to make it easier for the big toe to bend upward. Osteotomies are often performed together with cheilectomy.

  • Prof. Dr. Murat Bozkurt’s Approach: He uses osteotomies in selected cases to increase joint motion and improve joint biomechanics.

• Arthrodesis (Joint Fusion Surgery): One of the gold-standard treatment methods in advanced stages of the disease, when the joint cartilage is severely damaged and pain is severe. In this operation, the damaged cartilage surfaces of the big toe MTP joint are completely removed, and the joint is permanently fixed (fused) in an appropriate position using screws, plates, or wires. Arthrodesis completely eliminates motion in the joint but relieves pain to a great extent and allows the patient to walk comfortably.

  • Prof. Dr. Murat Bozkurt’s Approach: He regards arthrodesis as a reliable and effective solution for relieving pain and providing a stable weight-bearing surface in severe cases of Hallux Rigidus. This decision is made taking the patient’s activity expectations and lifestyle into account.

• Arthroplasty (Joint Replacement) / Interpositional Arthroplasty: Arthroplasty involves replacing the damaged joint surfaces with a metal or synthetic implant (prosthesis). The goal is to reduce pain while preserving joint motion. However, the long-term results and durability of big toe MTP joint prostheses are still debated, and this option is more often chosen for specific patient groups (such as older patients with lower activity expectations). In interpositional arthroplasty, soft tissue (such as capsule or tendon) is placed between the joint surfaces after they have been cleaned.

  • Prof. Dr. Murat Bozkurt’s Approach: He may consider arthroplasty options in rare, carefully selected cases, weighing the patient’s individual situation, expectations, and the advantages/disadvantages of current implant technologies. He generally gives priority to methods with proven and reliable outcomes.

When deciding on surgery, Prof. Dr. Murat Bozkurt conducts a thorough evaluation of the patient and selects and performs the most suitable surgical technique, taking into account the stage of the disease, the patient’s expectations, and lifestyle.

What Are the Benefits of Hallux Rigidus Surgery?

Although they vary depending on the surgical method used, the main benefits of Hallux Rigidus surgery are as follows:

• Reduced or Eliminated Pain: This is the most important benefit.
• Increased Range of Motion (Cheilectomy, Osteotomy, Arthroplasty): Improvement especially in upward bending of the big toe.
• Easier Shoe Wear: More comfortable shoe wear thanks to removal of bone spurs and reduced pain.
• Functional Improvement: Improvement in walking, running (after certain procedures), and other daily activities.
• Improved Quality of Life: A pain-free, more functional big toe leads to a marked improvement in overall quality of life.

Risks and Complications of Hallux Rigidus Surgery

As with any surgical procedure, Hallux Rigidus surgery carries potential risks and complications:

• Infection: Infection may develop at the surgical site.
• Nerve Damage: Temporary or permanent damage to sensory nerves near the surgical site (numbness, tingling).
• Persistent or Recurrent Pain: In rare cases, the expected pain relief may not be achieved.
• Persistent or Increased Stiffness: Especially after cheilectomy, sufficient range of motion may sometimes not be achieved.
• Nonunion or Malunion: Failure of the bones to heal as intended after arthrodesis or osteotomy surgery.
• Implant Problems (Arthrodesis, Arthroplasty): Loosening, breakage, or irritation related to the screws, plates, or prostheses used.
• Transfer Metatarsalgia: Pain resulting from load shifting to the base of the other toes, especially after arthrodesis.
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism: Serious complications that can occur, although rarely.

Prof. Dr. Murat Bozkurt exercises all necessary surgical care to minimize these risks and informs his patients in detail about them before surgery.

Recovery Process After Hallux Rigidus Surgery and Points to Consider

The recovery process after Hallux Rigidus surgery varies significantly depending on the surgical technique used:

• After Cheilectomy: A faster recovery is generally expected. Patients can usually begin controlled weight-bearing in a special surgical shoe shortly after surgery. Joint range-of-motion exercises are started early with physical therapy. Full recovery can take a few weeks to a few months.
• After Arthrodesis (Joint Fusion): Requires a longer recovery process. Typically, no weight-bearing or only partial weight-bearing is allowed for the first 6-8 weeks in a cast or special boot. Gradual weight-bearing and physical therapy begin once bone healing is complete. Full functional recovery can take 3-6 months or longer.
• General Recovery Recommendations:
  
  • Elevating the foot and applying ice in the first days after surgery reduces swelling.
  • Pain relievers prescribed by the doctor should be used as directed.
  • Dressings should be changed regularly and the wound kept clean.
  • Stitches are usually removed within 2-3 weeks.
  • The exercise program recommended by the doctor and physiotherapist should be followed precisely.
  • Smoking should be stopped completely, as it negatively affects bone healing and wound healing.
  • Follow-up appointments should not be missed.

Hallux Rigidus Surgery in Ankara and Prof. Dr. Murat Bozkurt’s Expertise

Ankara is a center with experienced specialists in foot and ankle surgery and modern treatment facilities. For a condition affecting quality of life such as Hallux Rigidus, consulting a specialist physician for an accurate diagnosis and appropriate surgical treatment is of great importance. Prof. Dr. Murat Bozkurt has extensive knowledge and experience in the surgical treatment of Hallux Rigidus in Ankara.

Prof. Dr. Murat Bozkurt’s approach to Hallux Rigidus surgery:

• Accurate Diagnosis and Staging: Accurately determines the stage of the disease and the patient’s individual needs.
• Personalized Surgical Planning: Determines the most suitable surgical technique (cheilectomy, arthrodesis, osteotomy, etc.) for each patient based on age, activity expectations, and severity of arthritis.
• Modern, Evidence-Based Techniques: Performs surgical interventions using the most modern techniques in light of current scientific data.
• Focus on Functional, Pain-Free Outcomes: Aims primarily to relieve pain through surgery and to help the patient achieve the best possible functional outcome.
• Comprehensive Follow-Up: Closely monitors the post-operative recovery process, providing the necessary support to help the patient return to daily life as quickly as possible.

If you are experiencing pain, stiffness, or limited motion in your big toe, you can consult Prof. Dr. Murat Bozkurt in Ankara for detailed information about Hallux Rigidus and surgical treatment options.

Contact and Appointment Call:

Don’t let the pain and stiffness in your big toe be your fate. To get rid of the limitations caused by Hallux Rigidus and improve your quality of life, you can contact Prof. Dr. Murat Bozkurt in Ankara. Call 0312 502 70 74 to learn about the correct diagnosis and treatment options tailored to you, and to schedule an appointment.