Hallux rigidus

definition

· limitation of dorsiflexion of hallux

· due to degenerative changes in MTP joint

epidemiology

· two peak presentations

· adolescence (females more common)

· middle age (males more common)

aetiology

· often idiopathic

· may be associated with

· local trauma

· osteochondritis dessicans

· crystal arthropathy

· inflammatory arthropathy

clinical features

History

· pain on walking

· esp. slopes and rough ground

· pain may become continuous

Examination

· hallux is straight

· MTP joint is enlarged and knobbly

· palpable dorsomedial osteophyte and bunion

· dorsiflexion restricted and painful

· show shows excessive lateral wear

· load taken on outside to avoid pressing on toe

radiology

· changes of osteoarthritis

· dorsomedial osteophyte

treatment

Nonoperative

· shoe with stiff last

· rockerbottom sole on shoe

Operative

· failed or unacceptable nonoperative treatment

Osteotomy

· indicated for

· adolescents

· adults with no degenerative changes and at least 30^o plantarflexion

· extension osteotomy of proximal phalanx

· to convert plantarflexion range into functional dorsiflexion

Cheilectomy

· indicated for adults with minimal degenerative changes

· removal of dorsal osteophytes

· to increase painless dorsiflexion range

· must remove at least 1/3 of dorsal aspect of MT head

· must remove osteophytes from base of P1

· disadvantages

· recurrence of pain

Arthrodesis

· indicated for adults with significant degenerative changes

· disadvantages

· lateral transfer metatarsalgia

· compensatory IP joint osteoarthritis

· malposition

· limitation of footwear type

· nonunion

Arthroplasty

· indicated for adults with low to moderate demands

· Swanson silicone prosthesis

· disadvantages

· breakage

· synovitis

Keller’s procedure

· indicated for elderly with low demands

· disadvantages

· cosmetically poor

· lateral transfer metatarsalgia