A toe no longer moves correctly and you start walking badly. All because of the rigid toe, a condition of the big toe of the foot as a result of degeneration of joint cartilage. Often the rigid big toe is accompanied by another condition, much more common and recognized than this one, namely the valgus toe. If at first recourse is made for conservative treatment, surgical intervention may be necessary to definitely resolve the rigid toe, as Dr. Leonardo Maradei, Head of Foot Surgery and minimally invasive techniques at Humanitas, explains.
Even athletes are at risk
The joint whose tissues are undergoing degeneration is the metatarsus phalangeal joint: the toe loses its physiological articular mobility. It is a condition that affects men and women without distinction, unlike the valgus toe that is more common in women: “The valgus toe qualifies for a lateral deviation of the toe, with its base moving outwards and the tip pointing markedly towards the other toes. The valgus toe is associated with pain and functional limitation,” explains Dr. Maradei.
Hallux valgus and rigid toe are correlated: “This is because the valgus toe is a common cause of arthrosis and therefore the toe becomes rigid because it is arthrosic,” recalls the specialist again. However, another cause can also hide behind this condition: “In addition to arthrosis, repeated traumas and microtraumas that affect the first toe, with the consequent joint lesions, can also lead to a rigid toe. That’s why the problem can also affect those who devote themselves to football.
The diagnosis is clinical but the specialist, in addition to observing the patient, may also require an X-ray before defining the treatment. The first step is the conservative one: “Damage to the mobility of the joint leads to a problem in walking, which is often painful. The subject is unable to dorsoflex the toe, i.e. to perform the movement in which the toe faces an upward direction, and then begins to walk wrongly by moving the weight to the outer edge of the foot”.
The pain also arises because osteophytes can form at the joint level, i.e. small bony spurs in the space between the two extremities of the joints rubbing against the shoes.
“The primary objective of conservative treatment is to restore greater mobility for walking properly. A physiotherapist will perform exercises for stretching of the metatarsalsophalangeal joint capsule. Even a foot bed – adds the specialist – can be used in the first phase of treatment”.
If stretching and a foot bed cannot solve the problems arising from the rigid toe, surgery is necessary: “If the condition is not very severe, a mini-invasive procedure can be performed to eliminate osteophytes. In more serious cases, a traditional surgical procedure is performed with which the joint capsule is opened and cleaned, while in even more serious cases metatarsalso-phalangealangeal arthrodesis is performed to surgically weld the metatarsus to the phalanx and fix the two heads of the joints,” concludes Dr. Maradei. If necessary, surgery can simultaneously correct the valgus toe.