Definition of hallux rigidus
Hallux rigidus is a loss of mobility of the big toe (hallux) metatarso-phalangeal joint (MTP). It is the advanced stage of osteoarthritis of this joint. It is annoying to walk because propulsion and extension of the great toe (around 40°) are missing.
Clinical exam
Walking is modified in order not to stress the stiff and painful joint. Bone (osteophytes) can grow around the sick joint. Bumps are felts under the skin and enter in conflict with the shoe.
Hallux rigidus: bone production at the dorsal aspect of the joint, visible under the skin, in conflict with the shoe
X rays
They easily highlight the osteoarthritis signs : narrowing of the joint space, abnormal bone production around the joint (osteophytes).
Hallux rigidus: narrowing of the joint space on the X ray
Hallux rigidus: bone production visible on the X ray, called osteophyte.
Treatment
Pain killers, anti-inflammatory, infiltrations and orthopedic insoles can help for a while, but the surgical treatment becomes on day inevitable.
When it is possible, a conservative procedure is chosen to preserve the joint and improve its function. The first metatarsal can be shortened ans tendons percutaneously cut. On this X ray, the surgical shortening of the first metatarsal re-opens the joint space and increases the mobility.
Hallux rigidus : the joint wear is visible on the X ray with a narrowing of the joint space.
When wear is too advanced, a permanent fusion of the joint called arthrodesis is the only option. When properly performed it causes no inconvenience in walking and is not visible. Walking lays indeed on an articular chain. Fusing one of the joints stiffens the chain but the pain’s extinction improves considerably the situation. Sports and hiking are possible but of course not dancing on the tip the great toe… Wearing heel shoes up to 4 cm height is also possible.
Hallux rigidus: major joint wear leaves no other option than fusion, called arthrodesis.
Finally, numerous prosthesis have been suggested. Their reliability hasn’t been demonstrated yet.
