Foot and Ankle Surgery

Hallux Rigidus

hallux rigidus

Hallux Rigidus

Hallux rigidus is seen in the first metatarsophalengeal joint of the foot. It is charecterized with pain and limitation of joint motion in the first metatarsophalengeal joint. Dorsiflexion motion is particularly restricted. Progressive joint degeneration and osteoarthritis are seen in Hallux rigidus disease.

What is the etiology of Hallux Rigidus?

Halluks rigidus is more common in patients with severe pes planus due to the excessive load on first metatarsophalengeal joint. People standing on their tiptoes most of the time, and persons staying in crouched position for long times are prone to develop hallux rigidus. Direct blows and traumas may also cause joint degeneration. Hallux rigidus is also common in rheumatoid arthritis and gout arthropaties.

What are the clinical findings of Hallux Rigidus?

Pain and activity limitation are the most common early complaints. Pain is felt worse in cold and rainy weathers. It is typical for
the patients with Halluks rigidus to have pain in crouch position and during running due to the increase load to first metatarsophalengeal joint. Occasionally, patients may have swelling and redness in the joint following physical activity. In more severe stages, patients experince pain in rest as well. Bony spurs may cause shoe fitting problems. Patients are generally uncomfortable with shoes which are narrow,  point tip and elastic soles. Patients usually alter their walking pattern may occasionally limp.

How can Hallux Rigidus be diagnosed?

halluks rigidus

Itcan be diagnosed with limitation of first metatarsophalengeal joint dorsiflexion which is between 55-70 degrees normally along with bone bump formation dorsal part of the joint. Radiographs may demostrate dorsal beaking in both metatarsal and phalengeal joint surfaces and joint space narrowing in severe cases.

What is the treatment?

Rest, anti-inflammatory medicine, ice application may alleviate  the acute pain and swelling. Hard sole shoes are recommended in the early stages of the disease. Patients with hallux rigidus also benefit from shoes with large and high toe box. If the patient still has complaints despite the conservative treatment, surgical treatment may be inevitable.

What is the surgical treatment?

Removal of the bony spurs may help in the treatment of early stage diseases. Patients usually gain joint range of motion after surgery.

If  arthrosis developed,  treatment options would be whether arthrodesis of the joint or arthroplasty. One should keep in mind that even though one may gain range of motion with prosthesis surgery, the complication rates and recurrent surgery risks are higher in athroplasty then arthrodesis.

 

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About the author

Prof.Dr. Seref Aktas