Hallux rigidus

• Hallux rigidus:

  • Osteoarthritis of big toe joint - first MTP joint
  • Means "stiff great toe" - common cause of forefoot pain
  • A gradual condition where degenerative changes to bone prevent normal movement of big toe and the joint becomes stiff
  • Usually in people over 40
  • Most cases are bilateral
• Causes:

  • No specific cause
  • Most cases idiopathic
  • Develops over time
• Risk factors:

  • Trauma
  • Family history
  • Age >50
  • Athletes
  • People on feet all day
• Signs/symptoms:

  • Pain at top of big toe joint
  • Pain worse with walking, worse when wearing heels
  • Stiff joint - difficult to bend it
  • Bony lump/soft tissue swelling on top of big toe that may hurt when it rubs against shoe
  • Numbness or tingling if bony lump presses on nerves
• Diagnosis:

  • Clinical based on history and examination
• Investigations:

  • Sometimes X-ray is done to look for degenerative changes e.g. joint space narrowing, bone spurs
• Management:

  • Conservative - Ice, modify shoes and activities, orthotics and strapping the toe, NSAIDs, steroid injections
  • Surgery - if ongoing pain despite conservative management - cheilectomy - removal of bone spurs
• Prognosis:

  • Depends on severity
  • Most can manage symptoms with conservative management
  • Surgery is only way to definitively treat
• Hallux rigidus can be graded in severity:

  • 0 = normal
  • 4 = severe