What is it?

Hallux Rigidus is the medical term for degenerative joint disease of the first metatarsophalangeal joint or more simply, osteoarthritis of the first toe. This degeneration causes pain and limited movement at the joint. As the disease progresses, it may cause difficulty walking long distances, running or standing for prolonged periods of time. It is associated with generalized osteoarthritis and with repetitive joint trauma. Hallux rigidus is mostly seen in women and in athletes that have repetitive foot trauma such as soccer players, runners and ballet dancers.

Symptoms/Risks

Common symptoms of hallux rigidus include:

• Pain, especially while walking
• Swelling
• Limited joint movement
• Pain while wearing tight shoes or after standing for prolonged periods

Sports Medicine Evaluation

As part of the evaluation, the physician will review the patient’s symptoms and risk factors and will perform a physical exam that will include feeling the affected joint. The doctor will also observe the patient’s toes for swelling, abnormal alignment and limitations in movement. X-rays could be used to evaluate the degree of joint damage and rule out a fracture.

Hallux rigidus can be classified in three stages based on x-ray findings:

• Grade 1 - small bone spurs with good joint space
• Grade 2 - moderate bone spurs with joint space narrowing
• Grade 3 - severe bone spurs, severe joint narrowing and loose bodies floating in the joint

Treatment

The approach for treating osteoarthritic joints should always be conservative and will focus on treating the associated symptoms. As the condition progresses, more invasive options can be explored.

Hallux rigidus can be treated with some of the following methods:

• Applying ice to the toe for 10-15 minutes 2-3 times a day
• Drugs: oral non-steroidal anti-inflammatory drugs may provide relief
• Shoe changes: using shoes that do not put pressure on the affected toe such as a steel shank shoe and/or wide-toe box, avoiding high heel shoes
• An ultrasound guided joint injection of local anesthetic with steroid could be used to relieve symptoms for a couple of weeks, even months

If conservative treatment fails, surgical options could be explored, including a joint debridement to remove spurs and/or loose bodies or an arthrodesis which stabilizes the joint.

Return to Play

The patient is allowed to perform activity as tolerated. Certain activities that aggravate symptoms may be best to avoid or, at least, reduce the frequency of the activity.

AMSSM Member Authors
Cándido Vélez, MD and Fernando Sepúlveda-Irizarry, MD

References
Frontera WR, Silver JK, Rizzo TD. (2015) Essentials of Physical Medicine and Rehabilitation: Muskuloskeletal Disorders, Pain and Rehabilitation. Philadelphia, PA: Saunders
Jones MD, Sweet KJ (2017) Comparison of Hallux Rigidus Surgical Treatment Outcomes Between Active Duty and Non Active Duty Populations: A Retrospective Review. Journal of the American Podiatric Medical Association