Definition

Hallux Rigidus is a painful loss of motion of the MTP joint of the great toe.  Hallux Rigidus is an arthritic condition of the MTP joint, resulting in bony osteophytes, bony sclerosis, and loss of joint space.  In advanced cases, flattening of the metatarsal head and loose bodies may be present

Symptoms

The clinical picture is one of an enlarged first MTP joint, which may be palpable on the skin.  Dorsiflexion of the toe is markedly reduced, and painful, with a sensation of an abrupt bony block.  Pain is usually present with any walking, as opposed to Hallux Valgus (bunion) patients, who have pain only while wearing shoes.  Walking in a shoe with an elevated heel or hyperflexible sole increases the pain.

Causes

In the adolescent or middle aged, it is primarily a result of previous trauma.  Turf toe relates to the acute sprain injury to the capsule of the MTP joint.  Turf toe can lead to Hallux Rigidus.  In the older population, it is a form of degenerative arthritis.

Treatment

Initial treatment of Hallux Rigidus is conservative with modification of shoe wear.  A still sole decreases the range of motion of the painful joint, and an enlarged toe box will more easily accommodate the swelling.  A metatarsal rocker bar can be placed on the sole to relieve some of the stress on the MTP joint and aid in walking.  A soft cushioned rubber sole, with a metal or fiberglass plate in between the layers may also be used.  Nonsteroidal anti-inflammatory drugs (NSAIDs) may be beneficial on a short-term basis.

Surgical treatment takes the form of a cheilectomy, which involves excision of the dorsal osteophytes on the metatarsal head and base of the proximal phalanx.  Thirty to forty percent of the articular surface is removed as well, to increase the overall range of motion of the joint.  Early postoperative range of motion exercises are important to maintain the motion achieved during surgery.  If the arthritic changes in the joint are too advanced, a bony arthrodesis or fusion is performed.  In this case, pain is relieved at the expense or loss of joint motion.