Hallux rigidus

Michael W. Bowman M.D.

The great toe of the human foot is called the Hallux in Latin. Rigidus means stiffness. Hallux rigidus describes arthritis of the first toe MTP joint.  This may occur as the result of osteoathritis, rheumatoid arthritis, lupus, gout or after a fracture involving the joint.  Grade 1 hallux rigidus is also known as hallux limitus. There may be limited swelling and tenderness at the first MTP joint as well as reduced range of motion. x-rays of the first MTP joint may be normal. Normal first MTP motion is from 90 degrees of upward motion or dorsiflexion to 30 degrees of downward motion or plantar flexion. grade 2 hallux rigidus will also have swelling, stiffness and tenderness of the first MTP joint.  There may be a bony or cartilage prominence on the top or dorsum of the first MTP joint. x-rays may reveal small bony spurs at the periphery of the first MTP joint.  The cartilage joint space in between the bones of the MTP joint is still relatively preserved.  Grade 3 hallux rigidus will exhibit significant stiffness, tenderness and spurring at the first MTP joint. x-rays will display significant spurring, narrowing of the joint space and sclerosis or hardening of the bone surrounding the joint.

Treatment for grade 1 and grade 2 hallux rigidus is initially conservative.  Anti-inflammatories, ice and therapy they be used to reduce swelling and inflammation and restore range of motion.  A protective carbon fiber plate may be placed in the shoe to limit stress on the first MTP joint during push off while walking. A cortisone and Xylocaine injection in the MTP joint may also be used to reduce inflammation. In early grade 1 hallux rigidus and in certain cases of early grade 2 hallux rigidus A. PRP injection may help.  In cases of grade 2 hallux rigidus where there are significant spurs, a cheilectomy (bumpectomy in Greek) may be performed.  This is an outpatient procedure under general or spinal anesthesia.  An incision is made over the top or dorsum of the first MTP joint, the joint is opened and all of the spurs are removed. after surgery, a protective boot and nonweightbearing is continued for 6 weeks.  Early aggressive range of motion of the MTP joint is initiated.  Strengthening is initiated after 6 weeks.  Risks with this procedure include anesthesia related risks, wound healing problems infection, further later arthritis. cases of grade 3 hallux rigidus that have not responded to conservative treatment will usually require MTP fusion. this is an outpatient procedure under general or spinal anesthesia which results in fusion or permanent stiffening of the MTP joint.  An incision is made on the top or dorsum of the first MTP joint, the remaining cartilage surface of the MTP joint is removed and a small plate and screws are inserted to hold the two bones together until healed.  Postoperatively a protective boot and nonweightbearing her utilized for 6 weeks or until the fusion has healed.  Risks with this procedure R. anesthesia related risks, wound healing problems infection, slow healing or nonhealing of the fusion.