Stiff big toe
PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and range of motion (ROM) Associated with Localized Inflammation1
A 72-year-old male presents with big toe pain on his right foot. Patient likes to play tennis and said when he reached to hit a ball he started having toe pain. The pain has become so bad he cannot come up on his toes when he tries to serve. X-ray shows degenerative changes at the metatarsophalangeal (MTP) joint along with stiffness with MTP joint mobility.
Stiff big toe or rigid first ray
Arthritic degeneration of great toe (hallux)
Progression to bone spurs at first MTP joint
Limited MTP joint mobility
Bump or callus on MTP joint
Altered mechanics during push-off phase of gait
Diagnosis usually made by clinical examination or x-ray
May be independent diagnosis, not associated with disease process
Grade 0: Dorsiflexion (DF) of 40 to 60 degrees, normal radiograph, no pain
Grade 1: DF 30 to 40 degrees, dorsal osteophytes, some loss of ROM of the first MTP joint
Grade 2: DF 10 to 30 degrees, greater loss of ROM and cartilage, osteophytes, flattening of the MTP joint
Grade 3: DF of less than 10 degrees, significant cartilage loss with irregular sesamoids, constant pain
Grade 4: Hallux rigidus, radiograph showing loose bodies and pain throughout the ROM
Radiographs of a patient with bilateral hallux limitus. On the left there is flattening of the metatarsal head and slight joint space narrowing. There is marked joint space narrowing on the more severely affected right first MTP joint. (From Imboden J, Hellmann DB, Stone JH. Current Diagnosis & Treatment in Rheumatology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Sensory innervation of the foot. n., nerve. (From Tintinalli JE, Stapczynski JS, Ma OJ, et al., eds: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Generalized degenerative arthritis
Poor footwear: Improper fit, pointed toe, narrow forefoot
Dancers at higher risk
Most common form of arthritis in foot
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