Hallux rigidus (hallux limitus)
What is Hallux rigidus?
Hallux rigidus is the development of arthritis in the 1st metatarsal phalangeal joint, which over time leads to limited range of motion and pain. Hallux rigidus is a progressive condition, so over time you will develop more joint stiffness and pain.
What causes hallux rigidus?
Typically hallux rigidus is caused by a biomechanical/structural abnormality of the foot, such as elevated/plantarflexed metatarsal, short/long metatarsal, over use of the joint, repetitive micro trauma, acute damage to cartilage.
How to diagnose hallux rigidus?
Hallux rigidus can be diagnosed clinically with pain and limited range of motion of the 1st metatarsal phalangeal joint, often there are dorsal osteophytes on the 1st mtpj joint that can be palpated. X-rays are often taken which demonstrate loss of joint space, subchondral sclerosis, and development of osteophytes.
How to treat hallux rigidus?
The most common classification used to determine the stage of hallux rigidus is Coughlin and Shurna which help dictate treatment. Typically conservative treatment starts with NSAIDs, orthotics, activity modification, and steroid injection. If the patient continues to have pain than surgery is attempted and typically patients stages 1-2 get a cheilectomy or youngswick, stage 3 has variable treatments and will be determined by your surgeon, and stage 4 is often treated with fusion for implant.
Video of 1st mtpj implant: https://www.youtube.com/watch?v=iVgEJ8FryKg