Hallux Rigidus is a painful condition of the big toe joint characterized by restricted motion, especially in dorsiflexion, and proliferative bone formation around the joint. It is most commonly caused by repetitive microtraumas or acute injury to the joint. Conservative management includes medications like NSAIDs, joint manipulation, orthotics to stiffen the forefoot and reduce motion at the big toe joint, and footwear modifications. Surgical options like cheilectomy or joint fusion are considered if conservative care fails to provide relief from pain and stiffness.
2. • Reported in 1887 by Davies-Colley - Hallux Flexus
• Cotterill coined the term Hallux Rigidus
• DuVries in 1959 and Moberg - hallux rigidus is the most common
condition to affect the first MTP joint
• Also called as
- hallux limitus
- dorsal bunion
- hallux dolorosus
- hallux malleus
- metatarsus primus elevatus (MPE)
3. • Painful condition of
great toe MTP joint
• Characterized by
- Restricted motion
(mainly
dorsiflexion)
- Proliferative periarticular
bone formation
7. • Swollen metatarsophalangeal
(MTP) joint
• Everted gait
• Numbness develops over medial
sensory nerve to the hallux
• Callus develops on lateral heel
because of everted gait
• Hyperextension of hallux
interphalangeal joint
8. • Initial stages
- Nonuniform joint space
narrowing
- Widening and flattening of first
metatarsal head
• Advanced stages
- Subchondral cysts and sclerosis
of metatarsal head
- Widening of base of proximal
phalanx
- Hypertrophy of sesamoids
9. • Clinical
- Only stiffness
- Loss of passive motion
• ROM
- Dorsiflexion 40-60
• Radiograph
- Normal
• Clinical
- Occasional pain
- Pain at extremes of dorsiflexion
• ROM
- Dorsiflexion 30-40 degrees
• Radiograph
- Dorsal spur
- Min joint narrowing
- Min periarticular sclerosis
- Minimal flattening of metatarsal head
10. • Clinical
- Nearly constant subjective pain
substantial stiffness pain through out ROM
(but not at mid ROM)
• ROM
- 10 degrees or less Dorsiflexion
• Radiograph
- Grade 2+ substantial narrowing, periarticular
changes,>25% joint space involved no dorsal
side,sesamoids enlarged
• Clinical
- Moderate to severe pain and stiffness
- Pain just before maximal dorsiflexion
• ROM
- Dorsiflexion 10-30 degrees
• Radiograph
- Osteophytes
- <25%dorsal joint space involved
- Mild to moderate joint narrowing and
sclerosis
11. • Clinical
- nearly constant subjective pain
andsubstantial stiffness
- pain through out ROM+definite oain at mid
ROM
• Radiograph
-Grade 2+ substantial
- narrowing,periarticular changes,>25% joint
space involved no dorsal side,sesamoids
enlarged
• ROM 10
- degrees or less Dorsiflexion