hallux rigidus

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 [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
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
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
High-heeled shoes

STJ, supratalar joint; MTPJ, metatarsophalangeal joint.

Table 2: Classification of stage of hallux limitus/rigidus
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 ?
This technique can be used for the management of severe hallux rigidus in active patients and for patients who are concerned with maintaining the active motion of the first metatarsophalangeal joint.
Coughlin MJ, Shurmas PJ: Soft tissue arthroplasty for hallux rigidus.
Lau JT, Daniels TR: Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus.
Mackay D, Blyth M, Rymaszawski L: The role of cheilectomy in the treatment of hallux rigidus.
Hamilton WG, O'Malley MJ, Thompson FM: Capsular interposition arthroplasty for severe hallux rigidus.
Quantitative review of operative management of hallux rigidus.
Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus.
Resection arthroplasty with and without capsular interposition for treatment of severe hallux rigidus.
Surgical treatment of hallux rigidus using a metatarsal head resurfacing implant: mid-term follow-up.
Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus.
Pain Relief and Functional Improvement With Metatarsal Resurfacing In Hallux Rigidus Preliminary Results In a Multicenter Case Series With A Surgical Alternative To Joint Fusion.
Roukis TS, Metatarsus primus elevatus in hallux rigidus.