Hallux Rigidus in Vienna
the stiff, painful big toe – preserved or reliably fused

Hallux rigidus is osteoarthritis of the big toe joint (the first metatarsophalangeal joint). The cartilage wears down, bony spurs form and the joint becomes progressively stiffer and more painful. Typical signs are pain when rolling off the foot, a visible bump on top of the joint and a big toe that can no longer bend upward properly. Over time the stiffness gives the condition its name – a rigid big toe.

They are two different problems of the same joint. Hallux valgus is a deformity – the big toe drifts sideways toward the other toes and a bump forms on the inner edge. Hallux rigidus is arthritis – the joint wears out and stiffens, with the bump usually on top of the joint. Hallux valgus is corrected by realigning the bone; hallux rigidus is treated by preserving or fusing the worn joint. Both can occur together, which is why an examination and X-ray are important.

No. In the early stages a stiff-soled or rocker-bottom shoe, insoles, anti-inflammatory measures and occasionally an injection can relieve the joint and ease the pain for a long time. Surgery becomes worthwhile when the pain persists despite these measures, when rolling off the foot becomes difficult, or when the joint stiffens further. The stage of the arthritis then decides whether the joint can be preserved or is better fused.

It depends on the stage. In early to moderate arthritis I preserve the joint with a cheilectomy: the bony spurs are removed and the joint is freed so the big toe can bend upward again and rolling off becomes pain-free. In advanced arthritis, when the cartilage is largely gone, a fusion (arthrodesis) is the most reliable solution – the joint is fixed in a functional position with a small plate or screws. This removes the pain permanently and gives a stable, load-bearing forefoot. The procedure is usually possible on an outpatient basis under regional anaesthesia.

Yes. This surprises many patients, but a fused big toe joint allows a smooth, pain-free and powerful gait. The movement that is lost was already painful and severely restricted by the arthritis. Rolling off is taken over by the neighbouring joints, so normal walking, hiking and most sports are possible again. What is limited is deep bending of the big toe – for example wearing very high heels or a deep squat on the ball of the foot. In return you gain lasting freedom from pain and full load-bearing capacity.

With supplementary (Sonderklasse) insurance the operation and hospital stay are generally covered in full and billed directly with your insurer. Without supplementary insurance the procedure is possible as a self-payer at any time – you receive a transparent cost estimate in advance, with no hidden extras. The exact amount depends on the technique (joint-preserving cheilectomy or fusion) and the implants used, which is why I put it in writing before anything is decided. For practice visits, statutory insurers reimburse roughly 80% of their tariff afterwards.

Hallux rigidus belongs in the hands of an orthopaedic foot specialist. Dr. Philippe Ghobrial performs both the joint-preserving cheilectomy and the fusion himself and assembles the team that looks after you before, during and after the operation. He works exclusively as a private physician (Wahlarzt) but treats all patients – privately insured, Sonderklasse-insured and self-payers. As a Wahlarzt patient you can have part of the practice costs reimbursed by your statutory insurer afterwards.