Hallux Rigidus

Abstract

1. Clinically, hallux rigidus is a painful condition of the joints of the great toe associated with loss of dorsiflexion of the first phalanx. 2. Pathologically, the morbid changes are those of a traumatic synovitis followed by an early development of osteoarthritis, the initial lesions of which are erosions of the cartilage at the centre and near the dorsal margin of the base of the proximal phalanx. There is no fundamental pathological difference between the adult and adolescent varieties of hallux ngidus. Both represent stages in the developmental cycle of osteoarthritis in the proximal joint of the great toe. 3. The radiographic density and apparent fragmentation of the phalangeal epiphysis do not represent an abnormality of the bone and have no significance in the etiology of hallux rigidus. 4. The cause of hallux rigidus is an abnormal gait developed either to protect an injured or inflamed metatarso-phalangeal joint from the pressure of weight-bearing, or to stabilise a hypermobile first metatarsal. The effects of this gait are to transfer most of the pressure from the flexor brevis tendon and the two sesamoids to the base of the first phalanx. Excessive pressure on this joint predisposes to osteoarthritis. 5. Evidence of this abnormal gait is found in the peculiarities of wear seen in old shoes. 6. There is a high correlation between unilateral hallux rigidus and the patient's footedness.

Foot Disorders, Foot Posture, and Foot Function: The Framingham Foot Study

“…Clinical texts note planus foot posture and pronated function as possible causes of hallux rigidus [7]. However, Zammit et al reported no strong association between hallux rigidus and measures of foot posture in a systematic review of case control studies [32].…”

“…Foot posture and function are thought to be associated with disorders such as hallux valgus [6], hallux rigidus [7], Tailor’s bunion [8], and hammer toes [9,10]. However, many of these associations are based on clinical observations and have not been objectively validated.…”

Contribution of the Flexor Hallucis Longus to Loading of the First Metatarsal and First Metatarsophalangeal Joint

“…The initial pathological changes are the articular erosions on the dorsal aspect of the metatarsal head. 1,26 The proximate cause was speculated to be the forced extension and compression of the joint, perhaps from a tight flexor hallucis brevis. Numerous theories have been suggested for the etiology of hallux rigidus, including repetitive trauma, pes planus, long first ray, longer second metatarsal, metatarsus primus elevatus, and osteochondritis dissecans of the first metatarsal head.…”

“…This is consistent with the hypothesis that stenosing tenosynovitis of the FHL is an etiology of hallux rigidus, since the initial pathological changes are seen on the dorsal aspect of the metatarsal head. 1,27,38 …”

Joint Salvage Techniques for Stage III/IV Hallux Rigidus

“…Mechanical causes which include metatarsus primus elevatus, congenitally long first metatarsal, hypermobile first ray, pes planus, hallux equinus, hallux valgus and hallux varus [Nilsonne, 1930;Bonney & Macnab, 1952;Bingold & Collins, 1950;Lambrinudi, 1938]. These structural abnormalities alter the axis of motion of the first metatarsophalangeal joint.…”