II. Pathophysiology

  1. Traumatic Osteoarthritis of first metatarsophalangeal joint
  2. Occurs secondary to repeated dorsiflexion stress
  3. Results in restricted range of motion of great toe

III. Epidemiology

  1. Onset in ages 30 to 50 years old
  2. Incidence of significant Hallux Rigidus increases with age
    1. Effects 20% of patients by age 40 years old
    2. Effects up to 40% of men and 50% of women by age 70 years old

IV. Symptoms

  1. Gradually increasing great toe pain and stiffness
  2. Precipitated by minor injury
  3. Worse acute exacerbations with successive episodes
  4. Provocative
    1. Ambulation
    2. Dorsiflexion

V. 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

VI. Differential Diagnosis

VII. Imaging: Foot XRay

  1. Signs of Degenerative Arthritis
    1. First Metatarsal-phalangeal joint (MTP) narrowing
    2. Dorsal osteophyte (spur) formation

VIII. Management

  1. Rest
  2. Moist heat
  3. NSAIDs
  4. Orthotics to restrict MTP joint range of motion
    1. Rigid or other Inserts (OTC)
    2. Custom Orthotics
    3. Hard soled shoes
      1. Some recommend a rocker-bottom or curved sole shoe
    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
    2. Most symptoms improve without surgery
      1. Grady (2002) J Am Podiatr Med Assoc 92(2): 102-8 [PubMed]

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Ontology: Hallux Rigidus (C0264134)

Definition (MSH) A condition caused by degenerative arthritis (see OSTEOARTHRITIS) of the METATARSOPHALANGEAL JOINT of the great toe and characterized by pain and limited dorsiflexion, but relatively unrestricted plantar flexion.
Concepts Acquired Abnormality (T020)
MSH D020859
ICD9 735.2
ICD10 M20.2
SnomedCT 156855004, 6654000
English Hallux limitus, feet hallux rigidus, hallux rigidus, hallux rigidus (physical finding), hallux rigidus (diagnosis), Hallux Rigidus, Rigidus, Hallux, Hallux Rigidus [Disease/Finding], Hallux;rigidus, hallux limitus, Hallux rigidus, Acquired hallux rigidus, HR - Hallux rigidus, Hallux rigidus - acquired, Rigidity of 1st MTP joint, HL - Hallux limitus, Acquired hallux rigidus (disorder), hallux; rigidus, rigidus; hallux
Portuguese Hallux Rigidus, Dedo grande rígido, Hálux Rígido
Swedish Hallux rigidus
Czech hallux rigidus, Hallux rigidus
Spanish Hallux rigidus, artrosis de la primera articulación metatarsofalángica, hallux rígido adquirido, rigidez del dedo gordo adquirida (trastorno), rigidez del dedo gordo adquirida, rigidez del primer dedo del pie adquirida, Hallux Rigidus
Dutch hallux rigidus, hallux; rigidus, rigidus; hallux, Hallux rigidus
Italian Alluce rigido, Hallux rigidus
Japanese キョウゴウボシ, 強剛母趾
Finnish Jäykkä isovarvas
Russian BOL'SHOI PALETS STOPY REGIDNYI, HALLUX RIGIDUS, БОЛЬШОЙ ПАЛЕЦ СТОПЫ РЕГИДНЫЙ
Korean 엄지발가락 굳음증
Polish Paluch sztywny, Paluch sztywniejący
Hungarian Hallux rigidus
Norwegian Hallux rigidus
French Hallux rigidus, Hallus rigidus, Raideur du gros orteil
German Hallux rigidus