Hallux Rigidus

Aka: Hallux Rigidus, Hallux Limitus, Skier's Toe

1. Etiology
   1. Traumatic arthritis of first metatarsophalangeal joint
   2. Occurs secondary to repeated dorsiflexion stress
   3. Results in restricted range of motion of great toe
2. Epidemiology
   1. Onset in ages 30 to 50 years old
3. Symptoms
   1. Gradually increasing great toe pain and stiffness
   2. Precipitated by minor injury
   3. Provocative
      1. Ambulation
      2. Dorsiflexion
4. Signs
   1. First Metatarsal-phalangeal joint (MTP) inflammation
      1. Swelling
      2. Tenderness
      3. Restricted range of motion
   2. Great toe held in slight flexion
   3. Passive dorsiflexion painful
   4. Adjusted gait
      1. Weight shifted to outer Metatarsal heads
      2. Weight also shifted to lateral border of foot
5. Radiology: Foot XRay
   1. Signs of Degenerative arthritis
      1. First Metatarsal-phalangeal joint (MTP) narrowing
      2. Dorsal osteophyte (spur) formation
6. Management
   1. Rest
   2. Moist heat
   3. NSAIDs
   4. Morton's Extension Orthotic
      1. Rigid shank that supports length of toe
   5. Intraarticular Corticosteroid Injection
      1. See Great Toe MTP Injection
   6. Shoe with sufficient room in forefoot
      1. Anterior Metatarsal bar in shoe
      2. Rockerbottom shoe may be tried
   7. Surgery for refractory cases
      1. Arthroplasty or Arthrodesis