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Hallux Rigidus

Hallux rigidus is now the most universally accepted description of a condition in which there is a combination of restricted range of motion and degenerative arthritis of the first metatarsophalangeal joint (MPJ).

ETIOLOGY

Common causes include systemic arthritis, trauma, inflammatory disorders, neuromuscular disorders, congenital abnormality and iatrogenic events. History of trauma more common in unilateral disease while family history is usually present in bilateral disease .The prevailing thinking is that abnormality in dynamic foot function is the primary etiology of Hallux Rigidus. Patients with adult acquired flatfoot deformity and those wearing high heeled shoes are more prone to develop arthritis of the great toe joint. However, the true mechanism of dysfunction of the great toe joint during gait remains poorly understood.
Hallux rigidus

Hallux rigidus1

SYMPTOMS

  • First ray pain worse with push off or forced dorsiflexion of great toe
  • Deformity over the great toe joint in the later stages
  • Crepitus or a grinding feel in the joint when passively moved

Hallux rigidus2

TREATMENT OPTIONS

In the early stages we can give a trial of conservative therapy which can alleviate pain and prevent progression of the disease.

Stabilizing the foot

When pronation is controlled, the big toe no longer bears excessive weight. This reduces forceful and destructive compression of the cartilage i.e. medial wedges or heel cups.

Stabilizing the big toe

Preventing it from “over-flexing,” as it pushes us forward i.e. Morton’s Extension.

Providing shock absorption

Especially in high arched feet.

mortons_extension
Morton’s Extension

SURGICAL OPTIONS:

In advanced disease or those not responding to conservative therapy surgery is a useful option.

Dorsal Cheilectomy

Indicted in moderate Hallux Rigidus especially in patients who have pain with dorsiflexion. In this technique we resect 20-30% of metatarsal articular surface along with any osteophytes.

Joint Arthrodesis

Indicated in patients with significant joint arthritis. Dorsal plate with compression screw or transarticular screws can be used.

wt-bearing

wt-bearing1