Hallux Rigidus: Clinical Presentation and Management of the Stiff Great Toe


Hallux rigidus encompasses a spectrum of articular cartilage degeneration of the first metatarsophalangeal (MTP) joint. Patients usually present with a painful, stiff great toe with dorsal impinging osteophytes that restrict dorsiflexion and passive motion. Multiple conservative and surgical treatments are available for the management of hallux rigidus. Nonsurgical treatments for hallux rigidus aim to decrease synovial irritation and/or decrease motion at the great toe MTP joint via medication, injection, orthosis, shoe wear modification, and activity adjustment. If conservative management fails, then surgical treatment is selected according to the clinical and radiographic findings and the patient's goals and expectations. Surgical procedures are designed to preserve joint motion, resurface the joint to create motion, or eliminate joint motion. In patients with grade 1 or 2 (and sometimes those with grade 3) hallux rigidus, cheilectomy is a useful treatment option with good outcomes. In younger or active patients with higher grades or more diffuse joint involvement, arthrodesis is recommended. Resection arthroplasty (Keller procedure) or interpositional arthroplasty is indicated for older, low-demand patients. At this time, prosthetic replacement is not recommended for routine use.

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