II. Pathophysiology
- Traumatic Osteoarthritis of first metatarsophalangeal joint
- Occurs secondary to repeated dorsiflexion stress
- Results in restricted range of motion of great toe
III. Epidemiology
- Onset in ages 30 to 50 years old
-
Incidence of significant Hallux Rigidus increases with age
- Effects 20% of patients by age 40 years old
- Effects up to 40% of men and 50% of women by age 70 years old
IV. Symptoms
- Gradually increasing great toe pain and stiffness
- Precipitated by minor injury
- Worse acute exacerbations with successive episodes
- Provocative
- Ambulation
- Dorsiflexion
V. Signs
- First Metatarsal-phalangeal joint (MTP) inflammation
- Swelling
- Tenderness
- Restricted range of motion
- Great toe held in slight flexion
- Passive dorsiflexion painful
- Adjusted gait
- Weight shifted to outer Metatarsal heads
- Weight also shifted to lateral border of foot
VI. Differential Diagnosis
VII. Imaging: Foot XRay
- Signs of Degenerative Arthritis
- First Metatarsal-phalangeal joint (MTP) narrowing
- Dorsal osteophyte (spur) formation
VIII. Management
- Rest
- Moist heat
- NSAIDs
- Orthotics to restrict MTP joint range of motion
- Intraarticular Corticosteroid Injection
- Shoe with sufficient room in forefoot
- Anterior Metatarsal bar in shoe
- Rockerbottom shoe may be tried
- Surgery for refractory cases
- Arthroplasty or Arthrodesis
- Most symptoms improve without surgery