This article reviews current literature available on hallux rigidus including its pathophysiology, clinical evaluation, operative and non-operative management.
An estimated 40 percent of the United States population have foot problems; of all patients aged over 50 years, 2.5 percent report degenerative arthritis of the first metatarsophalangeal (MTP) joint, termed ‘hallux rigidus’.
While arthritis can be caused by traumatic or iatrogenic injuries that directly cause damage to the articular cartilage of the MTP joint, most often the aetiology of hallux rigidus is idiopathic.
As hallux rigidus progresses, the normal coupling of the centre of rotation of the proximal phalanx and metatarsal head is disrupted, leading to eccentric gliding of proximal phalanx on the metatarsal head.
Patients typically present with a history of pain and stiffness that is worse with activities, particularly with first MTP dorsiflexion involvement, such as stairs, running or push-ups.
On examination, tenderness is localised to the dorsal joint and osteophytes can often be visualised and palpated.
Imaging should consist of standing anteroposterior (AP), oblique and lateral radiographs.
Treatment of hallux rigidus should begin with non-operative measures aimed at pain relief.
Non-steroidal anti-inflammatory drugs may alleviate acute episodes of exacerbation.
Activity modifications include avoiding those that involve extreme dorsiflexion of the first MTP such as stairs or running.
Orthotics are designed to limit motion across the first MTP joint while providing cushioning and plantar pressure distribution.
Non-operative treatment can be successful for many patients.
For patients with severe hallux rigidus, the ‘gold standard’ remains first MTP arthrodesis, where retrospective series as well as comparative studies have shown consistent success.
Newer techniques of interpositional arthroplasty as well as new hemi-arthroplasty designs, including metal resurfacing and synthetic cartilage implants, offer potentially promising options for preservation of motion.
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