Foot

Hallux Rigidus

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Hallux Rigidus, Hallux Limitus, Skier's Toe

  • 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
  • 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
  • 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
  • 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
  • Differential Diagnosis
  1. Gouty Arthritis
  1. Signs of Degenerative Arthritis
    1. First Metatarsal-phalangeal joint (MTP) narrowing
    2. Dorsal osteophyte (spur) formation
  • 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]
  • References
  1. Becker (2018) Am Fam Physician 98(5): 298-303 [PubMed]