Definition
Hallux rigidus is degenerative arthritis of the first metatarsophalangeal joint, producing pain and progressive restriction of dorsiflexion.
Clinical features
- Dorsal first-MTP pain
- Pain during terminal stance and toe-off
- Reduced dorsiflexion
- Dorsal osteophyte prominence
- Painful impingement in shoes
In advanced disease, pain occurs through the mid-range of motion as well as at terminal dorsiflexion.
Examination
Assess:
- MTP range of motion
- Pain at terminal versus mid-range motion
- Dorsal osteophytes
- Grind test
- Associated hallux valgus, first-ray elevation or lesser-toe disease
Imaging
Weight-bearing AP, lateral and oblique radiographs may show:
- Joint-space narrowing
- Dorsal osteophytes
- Subchondral sclerosis and cysts
- Flattening or irregularity of the metatarsal head
Non-operative treatment
- Activity modification
- NSAIDs or simple analgesia as appropriate
- Stiff-soled shoe
- Morton extension or rocker-bottom modification
- Injection in selected patients
Operative treatment
Cheilectomy
Best suited to mild or moderate disease where pain is predominantly from dorsal impingement and the joint retains useful cartilage and motion.
Moberg osteotomy
A dorsal closing-wedge proximal phalangeal osteotomy may be combined with cheilectomy in selected patients to improve functional dorsiflexion.
First-MTP arthrodesis
The most reliable procedure for painful advanced hallux rigidus with substantial joint-space loss.
Arthroplasty
Selected motion-preserving procedures exist but have less predictable long-term performance than arthrodesis in many high-demand patients.
References
- Orthobullets. Hallux Rigidus (MTP joint arthritis).