Hallux rigidus – stiff big toe

Hallux rigidus or literally translated „big toe“, is characterized by pain and limited mobility of the thumb upwards, with preserved possibility of bending the big toe downwards. Degenerative arthrotic changes in the basal (first metatarsophalangeal) joint of the big toe underlie this clinical entity.

Primary or juvenile hallux rigidus occurs in younger people and as a consequence of the ossification disorder of the first metatarsal bone, i.e. aseptic necrosis or osteochondritis dissecans. Secondary or adult hallux rigidus is of multifactorial genesis where degenerative changes dominate.

During examination we usually spot a bulge (exostosis) on the dorsal side of the basal joint. The big toe is usually extended, dorsal flexion is significantly reduced but plantar preserved. Diagnosis is confirmed with x-ray which shows classic signs of osteoarthritis: narrowing of the joint space, subchondral sclerozation and osteophytes (especially dorsal). Treatment is conservative and one of the most effective measures is wearing shoes with a cylindrical bottom which reduces painful dorsiflexion.

In case of progression of symptoms, surgery is advised. It's common procedures are cheilectomy (removal of the dorsal osteophyte and dorsal edge of the heal of the metatarsal bone) and stiffening (arthrodesis) of the basal big toe joint.

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