hallux rigidus


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hallux

 [hal´uks] (pl. hal´luces) (L.)
the great toe.
hallux doloro´sus a painful disease of the great toe, usually associated with flatfoot.
hallux flex´us hallux rigidus.
hallux mal´leus hammer toe affecting the great toe.
hallux ri´gidus painful flexion deformity of the great toe with limitation of motion at the metatarsophalangeal joint.
hallux val´gus angulation of the great toe toward the other toes of the foot.
hallux va´rus angulation of the great toe away from the other toes of the foot.

hal·lux ri·g'i·dus

a condition in which stiffness appears in the first metatarsophalangeal joint; usually associated with the development of bone spurs on the dorsal surface.
Synonym(s): stiff toe

hallux rigidus

a painful deformity of the great toe, limiting motion at the metatarsophalangeal joint.

hal·lux rigi·dus

(hal'ŭks rij'i-dŭs)
A condition in which there is stiffness in the first metatarsophalangeal joint; the joint may be the site of osteoarthritis.

hallux rigidus

A painful condition in which the joint between the first long foot bone (the metatarsal) and the nearer of the two bones of the great toe is unable to bend properly. This causes severe walking disability. An operation on the tendons may be necessary or a rocker bar may be fitted to the shoe.

hallux rigidus

ankylosis or grossly reduced sagittal-plane motion of first metatarsophalangeal joint (i.e. <5° available dorsiflexion); endpoint of progressive hallux limitus (Table 1 and Table 2; Figure 1)
Table 1: Factors that predispose to hallux limitus/rigidus
LocationFeatureCharacteristics
Intrinsic factorsFoot shapeRectus foot
Long first toe
Long first metatarsal
Biomechanical factors within the foot that cause excess STJ and MTPJ pronation, so that foot is pronated from midstance to toe offAnkle equinus
Pes planovalgus
Forefoot varus
Metatarsus primus elevatus
Hypermobile first ray
Flexor plate immobility
Plantar soft-tissue contracture
Functional hallux limitus
Structural anomalies that predispose to excess STJ and MTPJ pronationExternal tibial torsion
Tibial varum
Knee position variants
Femoral retroversion
Longer limb
Wide-based gait
TraumaOsteochondritis
Osteoarthrosis
Soft-tissue tears
Turf toe
Extrinsic factorsInflammatory joint diseaseRheumatoid arthritis
Gout/crystal arthropathy
Psoriatic arthropathy
Generalized osteoarthritis
Sesamoid degeneration
Occupational hazard - repeated forced dorsiflexion of the first MTPJ/stubbing the first toeCarpet laying
En pointe ballet dancing
Football
Netball
Tennis
High-heeled shoes

STJ, supratalar joint; MTPJ, metatarsophalangeal joint.

Table 2: Classification of stage of hallux limitus/rigidus
StageCharacteristics
Stage 1
Functional HL
∼60° available dorsiflexion at 1 MTPJ
Functional (weight-bearing) limitation of dorsiflexion at 1 MTPJ, with:
• 1 MTPJ painful under load
• Hypermobility of first ray
• No real joint deterioration, but some osteophytosis
• Non-weight-bearing 1 MTPJ dorsiflexion near normal
Stage 2
Mild structural HL
35-55° available dorsiflexion at 1 MTPJ
Structural limitation of dorsiflexion at 1 MTPJ
• 1 MTPJ painful after exercise/movement
• Broadening and flattening of 1 MTPJ surfaces
• Narrowing of 1 MTPJ space
• Moderate osteophytosis of 1 MTPJ area
• Local bone sclerosis
• Elevation of the first ray
• Sesamoid hypertrophy
• Reduced 1 MTPJ dorsiflexion (weight- and non-weight-bearing)
• Reduced heel lift
• 1 MTPJ crepitus
Stage 3
Moderate structural HL
15-30° available dorsiflexion at 1 MTPJ
Structural loss of dorsiflexion at 1 MTPJ
• Pain within 1 MTPJ
• Marked 1 MTPJ deterioration
• Loss of 1 MTPJ space
• Extensive osteophytosis
• Bone sclerosis
• Cystic degeneration of subchondral bone
• Joint 'mice'
• Hypertrophy of sesamoids
• Elevation of the first ray
• Loss of height of MLA
• Decreased calcaneal angle
• 1 MTPJ crepitus
• Marked reduction of heel lift
Stage 4
Severe HR
<15° available dorsiflexion at 1 MTPJ
1 MTPJ immobility
• 1 MTPJ ankylosis and loss of joint space
• Marked osteophytosis and increased bulk of 1 MTPJ
• Loss of heel lift and/or hyperextension of IPJ of hallux

1 MTPJ, first metatarsophalangeal joint; MLA, medial longitudinal arch; IPJ, interphalangeal joint.

Figure 1: Hallux rigidus. A: Hallux rigidus showing dorsiflexion of 1st metatarsal, thickening of IMTPJ area, plantar flexion of hallux proximal phalanx, dorsiflexion of hallux terminal phalanx, and hyper extension of hallux interphalangeal joint. B: DP radiograph of IMTP with hallux rigidus showing OA-type changes (loss of joint space, osteophytosis and subchondral cysts). This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006).
References in periodicals archive ?
6,7) Cheilectomy has had some success, but results are better with less severe hallux rigidus.
In more severe cases of hallux rigidus, arthrodesis (completely fusing the bones of the joint to make one continuous bone) is the current standard of care and can include a wide variety of fixation options to help alleviate pain and enhance functional and mechanical stability so that the patient may return to moderate activities.
There are four recognized stages of hallux rigidus based on severity.
William Montross with Front Range Orthopedics in Colorado Springs, CO to resurface the first metatarsal head during surgery for treatment of hallux rigidus.
The metatarsal phalangeal joint or great toe is considered one of the most common osteoarthritic joints and the often painful condition of hallux rigidus is reported to be present in females at a rate of 2:1 over males.
Hallux Rigidus is a disease that affects the head of the metatarsal often resulting in a painful and stiff first toe joint.