Hallux rigidus

Hallux rigidus: Description, Causes and Risk Factors: A condition in which stiffness appears in the first metatarsophalangeal joint; usually associated with the development of bone spurs on the dorsal surface. Hallux rigidusHallux rigidus is arthritis of the big toe joint. It is the most common arthritic condition of the foot and second only to hallux valgus (bunion) as a condition associated with the big toe. Females are more commonly affected than males in all age groups, and the condition typically develops in adults between the ages of 30 and 60 years. The true cause of hallux rigidus is not known. However, several risks factors have been identified and include an abnormally long or elevated first foot bone (metatarsal), differences in foot anatomy, prior traumatic injury to the big toe and family history. Most of these risk factors cause damage to the surfaces of the bone and lead to wear and tear of the joint, which in turn leads to arthritis. Prognosis depends on the severity, patient activity and expectation as well as the particular treatment used. Generally speaking, operative treatments are offered to patients' refractory to non-operative treatments. Symptoms: Pain in the joint when you are active, especially as you push-off on the toes when you walk. Diagnosis: In many cases, the diagnosis of hallux rigidus can be made by a physician on physical examination alone. He or she will examine the foot for evidence of bone spurs and check the MTP joint by moving it up and down to see how much motion is available without pain. X-rays may be performed to help understand the extent of joint degeneration and to show the location and size of bone spurs. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage. Treatment: Non-Surgical Treatment: Non-surgical management is always the first-line treatment for this condition. A physician may suggest pain relievers and anti-inflammatory medicines, ice or heat packs, or even injections into the joint to reduce pain and stiffness. Changes in footwear may also be suggested, including advice to avoid thin-soled shoes or high heels, wear wider shoes with a curved sole (rocker bottom), or even add shoe inserts that limit the motion at the MTP joint. Although these treatments may help decrease the symptoms, they do not stop the condition from progressing. Surgical Treatment: Surgical treatments for hallux rigidus are determined by the failure of non-surgical treatment and the extent of arthritis and deformity of the toe. Cheilectomy: For the more minor type of hallux rigidus, when the damage is mild-to-moderate, shaving the bone spur on top of the metatarsal (cheilectomy) is sufficient. Removing the bone spur allows more room for the toe to bend and alleviates pain caused when pushing off the toe. The advantages of this procedure are that it is joint sparing, preserves joint motion and maintains joint stability.
  • Arthrodesis: Advanced stages of hallux rigidus, when the joint damage is severe, are often treated by fusing the big toe (arthrodesis). In this procedure, the damaged cartilage is removed and the two bones are fixed together with screws and/or plates to allow for them to grow together. The main advantage of this procedure is that it is a permanent correction with elimination of the arthritis and pain. The major disadvantage is the restriction of movement of the big toe.
  • Interpositional Arthroplasty: For the patient with moderate-to-severe hallux rigidus who is unwilling to accept the loss of motion at the big toe, an interpositional arthroplasty may be an option. This procedure consists of taking away some of the damaged bone and placing a piece of soft tissue from the foot, such as tendon or capsule, between the joint to allow for some motion. The operation is effective but not as reliable or predictable as a fusion.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  

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