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hallux limitus/rigidus
Etiology:
- osteoarthritis of the 1st metatarsophalangeal (MTP) joint with dorsal osteophyte
Clinical manifestations:
1) pain in great toe
2) pain exacerbated with dorsiflexion of great toe
3) enlargement of 1st MTP joint
4) limited dorsiflexion of great toe
5) crepitus
6) pain with walking
Radiology:
- X-ray of foot
- joint space narrowing
- marginal exostosis formation -subchondral sclerosis
Management:
1) analgesics
2) physical therapy: ultrasound
3) glucocorticoid injection
- very short-term & minimal relief of symptoms from acute exacerbation
4) foot surgery under local anesthesia (safe, effective, 1st line [1])
- arthrodesis vs implant arthroplasty of the 1st MTP joint
- mechanical bridging of MTP joint to reduce dorsiflexion
- orthosis, steel plate, special shoes etc
- arthroplasty or joint replacement
- remove spurs
- restore motion
Related
hallux valgus
hallux varus
General
joint disease; articular disease; arthropathy
foot deformity
References
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Geriatric Review Syllabus, 10th edition (GRS10)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2019
- Park YH, Jung JH, Kang SH, Choi GW, Kim HJ.
Implant Arthroplasty versus Arthrodesis for the Treatment of
Advanced Hallux Rigidus: A Meta-analysis of Comparative Studies.
J Foot Ankle Surg. 2019 Jan;58(1):137-143. Review.
PMID: 30583775
- Hamid KS, Parekh SG.
Clinical Presentation and Management of Hallux Rigidus.
Foot Ankle Clin. 2015 Sep;20(3):391-9. Review.
PMID: 26320554
- Kunnasegaran R, Thevendran G.
Hallux Rigidus: Nonoperative Treatment and Orthotics.
Foot Ankle Clin. 2015 Sep;20(3):401-12. Review.
PMID: 26320555
- Drago S, Nazaroff H, Britton J, et al.
Assessment and management of atraumatic first metatarsophalangeal joint pain.
J Am Acad Orthop Surg. 2023;31(14):708-716
PMID: 37126849