1. Hallux Rigidus: Conservative care
Dr.Rajiv Shah
Foot & ankle surgeon
‘Foot & ankle orthopaedics’
Vadodara, Surat

2. • Reported in 1887 by Davies-Colley - Hallux Flexus
• Cotterill coined the term Hallux Rigidus
• DuVries in 1959 and Moberg - hallux rigidus is the most common
condition to affect the first MTP joint
• Also called as
- hallux limitus
- dorsal bunion
- hallux dolorosus
- hallux malleus
- metatarsus primus elevatus (MPE)

3. • Painful condition of
great toe MTP joint
• Characterized by
- Restricted motion
(mainly
dorsiflexion)
- Proliferative periarticular
bone formation

4. Trauma
Intra articular fracture
Single episode Repetitive micro traumas
Crush Injury
Acute chondral/
osteochondral injury
Forced hyperextension/
plantar flexion injury

5. Congenital flattened/squared
metatrsal head
Short first metatarsal
Long first metatrsal
Pes planus
Tight intrinsic muscles
Congruent MTP joint
Hindfoot pronation
Metatarsus primus
elevatus

6. Dorsal and
dorsolateral
exostosis
Bony ledge
Increased bulk
around the joint
Constricting
footwear Dorsal
exostosis
enlargement
Limitation of
dorsiflexion
Pain Swelling MTP synovitis
Late
Stage
Initial
Stage

7. • Swollen metatarsophalangeal
(MTP) joint
• Everted gait
• Numbness develops over medial
sensory nerve to the hallux
• Callus develops on lateral heel
because of everted gait
• Hyperextension of hallux
interphalangeal joint

8. • Initial stages
- Nonuniform joint space
narrowing
- Widening and flattening of first
metatarsal head
• Advanced stages
- Subchondral cysts and sclerosis
of metatarsal head
- Widening of base of proximal
phalanx
- Hypertrophy of sesamoids

9. • Clinical
- Only stiffness
- Loss of passive motion
• ROM
- Dorsiflexion 40-60
• Radiograph
- Normal
• Clinical
- Occasional pain
- Pain at extremes of dorsiflexion
• ROM
- Dorsiflexion 30-40 degrees
• Radiograph
- Dorsal spur
- Min joint narrowing
- Min periarticular sclerosis
- Minimal flattening of metatarsal head

10. • Clinical
- Nearly constant subjective pain
substantial stiffness pain through out ROM
(but not at mid ROM)
• ROM
- 10 degrees or less Dorsiflexion
• Radiograph
- Grade 2+ substantial narrowing, periarticular
changes,>25% joint space involved no dorsal
side,sesamoids enlarged
• Clinical
- Moderate to severe pain and stiffness
- Pain just before maximal dorsiflexion
• ROM
- Dorsiflexion 10-30 degrees
• Radiograph
- Osteophytes
- <25%dorsal joint space involved
- Mild to moderate joint narrowing and
sclerosis

11. • Clinical
- nearly constant subjective pain
andsubstantial stiffness
- pain through out ROM+definite oain at mid
ROM
• Radiograph
-Grade 2+ substantial
- narrowing,periarticular changes,>25% joint
space involved no dorsal side,sesamoids
enlarged
• ROM 10
- degrees or less Dorsiflexion

12. Management
Conservative
Surgical
•Cheilectomy
•Phalangeal osteotomy
•Plantar flexion osteotomy
•Arthroplasty
•Arthrodesis

13. NSAIDs: reduces inflammation
& pain due to synovitis
Modification of activities
Neurotropics: if neuritic pain Steroid injections

14. •Morton’s extension
•Carbon fibre plate insert
•Commercially available
inserts
•Custom mould inserts
Tapping
Footwear modifications
Orthotics:
To stiffen the fore foot
To offload forefoot
To reduce the forefoot/MTP
joint motion
•Stiff insoles
•Rocker bottom shoe
•Still medial shank
•Wide/deep toe box
•Low heels
Joint manipulation

15. That’s all…
Thank you all…