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).
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.
In the early stages we can give a trial of conservative therapy which can alleviate pain and prevent progression of the disease.
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.
Preventing it from “over-flexing,” as it pushes us forward i.e. Morton’s Extension.
Especially in high arched feet.
In advanced disease or those not responding to conservative therapy surgery is a useful option.
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.
Indicated in patients with significant joint arthritis. Dorsal plate with compression screw or transarticular screws can be used.