Rigid big toe (hallux rigidus)

Osteoarthritis of the first metatarsophalangeal joint is very common. It is most often caused by abnormal position of the first metatarsal due to excessive eversion (pronation) of the foot at the subtalar joint, lateral deviation of the big toe (hallux valgus), plantar flexion of the first metatarsal, increase in its length, or medial deviation. In some cases, trauma may play a role.

Clinical picture

Initially, the only symptom may be slight swelling of the joint due to thickening of its capsule. The joint is painful, shoes worsen the condition. In the future, the pain may intensify, exostoses form, leading to limited mobility of the joint, and the patient stops bending it when walking. The movement now occurs mainly in the interphalangeal joint of the thumb, and an accentuated fold of skin is formed around it. Later, as a result of secondary involvement of the synovium, hyperthermia in this area may appear - a sign that usually does not occur initially.

Diagnosis

The diagnosis is established upon examination: the first metatarsophalangeal joint is enlarged, its movements are limited, palpation of the capsule is painful (especially on the lateral side), the distal phalanx of the finger is in dorsiflexion. In severe cases, radiography in a direct projection reveals osteophytes on the lateral side, and in a lateral projection - dorsal exostoses emanating from the head of the metatarsal bone.

Treatment

In the initial stage, the goal is to increase the mobility of the affected joint, for which passive exercises and traction are used. Periarticular infiltration with lidocaine (1.5 ml of a 2% solution containing adrenaline at a dilution of 1:100,000) can reduce pain and muscle spasm and thereby increase range of motion. Intra-articular injections of insoluble corticosteroids (eg, 1/4 mL triamcinolone acetonide, 40 mg/mL, combined with 3/4 mL 2% lidocaine) into painful trigger points in the joint may also be helpful.

Early stabilization of the foot helps restore proper position and function of the first metatarsal. In cases that are not amenable to conservative therapy, to reduce pain it is recommended to limit movements in the affected joint (for example, using special devices and orthopedic shoes). Surgical treatment may also be required.

Ed. N. Alipov

"Rigid big toe (hallux rigidus)" - article from the section

In order to prevent rigidity of the first metatarsophalangeal joint (MTP1), daily development of the range of motion in the joint is necessary. Developing range of motion is important to achieve better postoperative results and allows you to:

• Prevent thumb stiffness;
• Prevent the formation of painful adhesions (scars);
• Accelerate postoperative rehabilitation;
• In the long term, after 4-6 months, wear dress shoes, including high-heeled shoes.

The recovery process directly depends on your desire and attention. If you experience difficulty performing an exercise during your rehabilitation, consult your doctor.

First and second weeks after surgery

Rest and elevated position of the lower extremities. There are no exercises necessary during this period.

Third and fourth weeks

Start with moderate intensity exercise. Grab your thumb at the base, close to the metatarsophalangeal joint. Do not confuse the interphalangeal joint (IPJ) with the metatarsophalangeal joint. The interphalangeal joint is located in the middle of the finger, closer to its nail plate. Gently straighten your finger in an upward motion until you feel resistance and mild discomfort. Then hold your finger in this position for ten seconds. Repeat this exercise three times, then bend your finger, moving downward, until you feel the same sensation, repeat the exercise three times, ten seconds each. This series of exercises should be performed three times a day for the second week.

Fifth and sixth weeks

During this period, manual development movements should be increased to approximately six times per day with a gradual increase in strength and intensity.

Seventh week

Start a set of exercises under weight load. This exercise is performed in a standing position, by lifting the heel up without lifting the toes from the surface; this exercise allows, under the influence of body weight, to gradually increase the amount of extension in the toes. Stand on your toes for about ten seconds (after week six!!). Start walking uphill to increase finger extension. Walking with long strides is also effective - this is an excellent exercise for increasing flexibility in the first metatarsophalangeal joint.

Apart from this, you can also do the following exercises:

With one hand, grab the front of your foot, up to the base of your big toe. With your other hand, grab the base of your thumb, close to the metatarsophalangeal joint. The first step is to stretch the big toe, as shown in Figure A. Then stabilize the forefoot by holding it with your hand, as shown in Figure B, with the other hand, pull the big toe up, without twisting, the direction of the forces is indicated by the arrows in the figure, while keeping the foot bend (keep your finger straight). Hold your finger in this position for 10 seconds and repeat the exercise three times. Perform a similar exercise, but with the big toe shifted downwards, keeping the foot straight, as shown in Figure B, the direction of the forces is indicated in the picture. Hold your finger in this position for about ten seconds and repeat the exercise three times. These exercises should be performed six times a day.

Leg muscles are a painful condition that is based on increased muscle tone in the presence of constant resistance during passive movements. Also, the main symptom can be considered the inability to completely relax muscles. This condition is not a separate disease, but acts as a symptom of certain pathologies that most often relate to the activity of the nervous system.

In this case, diagnosis and proper treatment of the diseases that caused this pathology are of great importance.

The main manifestations of leg muscle rigidity include muscle tension that increases over time and the presence of muscle spasms. It all starts with the muscles of the body, and after some time the disease begins to affect the muscles of the legs or arms. The pathology, as mentioned above, is based on various diseases of the central nervous system, which are based on the increased excitability of alpha motor neurons in the anterior horns of the spinal cord. What exactly causes this pathology has not yet been clarified.

Increased tone can be spastic and rigid. Spastic spreads unevenly and selectively. Rigid, also called plastic, spasms all muscles at once. As a result of this, all sorts of difficulties can arise - in this case they will be related to walking. This condition can be caused by:

1. Stroke.
2. Brain injuries.
3. Sclerosis.
4. Disorder of the conduction of nerve impulses.
5. Hypoxia.
6. Encephalitis.
7. Meningitis.
8. Phenylketonuria.

Main features

Determining leg muscle stiffness is not that difficult. This disease has clearly defined symptoms that can be determined not only by the doctor, but even by the patient himself. If at least one of them is present, consultation with a specialist is urgently required.

What you need to pay attention to first:

1. Muscle tension.
2. Inactivity in the legs.
3. Feeling of discomfort while moving.
4. Stiffness.
5. Spasms.
6. Increased tendon reflexes.
7. Slow relaxation of spasming muscles.

Other symptoms include sleep disturbances, instability of emotional state, and decreased appetite. Often people with rigidity move exclusively on their toes, not only in childhood, but also as adults.

In the most advanced cases, the affected muscle becomes so dense that it is almost impossible to feel it, and any touch, even the lightest, for example, a massage, can cause severe pain.

An accurate diagnosis may require a visit to the doctor and some diagnostic tests and studies, such as a blood test, MRI or EMG. Consultation with specialists may be necessary after the initial diagnosis.

Complex therapy

Treatment should take place in two stages. In the first case, the underlying disease that caused the rigidity is treated. At the second stage, the muscle spasm itself is treated. But only complex therapy, which includes not only the use of medications, but also massage, physical therapy, and psychotherapy, can finally help overcome the disease.

Medicines are primarily needed to reduce pain and normalize the functioning of the nervous system. They should be selected strictly individually, and preferably in a hospital setting. The main drugs can be considered muscle relaxants and antipsychotics. Moreover, the doctor can prescribe only one drug, or a combination of two or three at the same time.

Correctly selected physical exercises will allow you to establish independent movements. Moreover, the exercise therapy complex should be aimed not only at relaxation, but also at stress. This should be done from the very first day of the disease. And you can supplement gymnastics with a massage, and you can do it either independently or with a specialist. It is advisable to massage different muscle groups.

Surgery is a last resort measure used when drug treatment and other methods have not produced any effect. Doctors recommend that many patients undergo a rehabilitation course with a psychotherapist, and also be sure to undergo a course of treatment in a neurological sanatorium. Sometimes this allows you to get a positive result much faster than when taking medications.