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Condition/Disorder Synonyms

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  • Stiff big toe

  • Hallux limitus

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ICD-9-CM Code

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  • 735.2 Hallux rigidus

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ICD-10-CM Code

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  • M20.20 Hallux rigidus, unspecified foot

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Preferred Practice Pattern

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Key Features

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Description

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  • Stiff big toe or rigid 1st ray

  • Arthritic degeneration of great toe (hallux)

  • Progression to bone spurs at 1st metatarsophalangeal (MTP) joint

  • Limited MTP joint mobility

  • Bump or callus on MTP joint

  • Altered mechanics during push-off phase of gait

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination or x-ray

  • May be independent diagnosis, not associated with disease process

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General Considerations

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  • Bone spur, osteophyte

  • Swelling

  • Inflammation around joint

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Demographics

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  • Adults

    • Generalized degenerative arthritis

    • Poor footwear: improper fit, pointed toe, narrow forefoot

    • Dancers at higher risk

    • Most common form of arthritis in foot

  • Adolescents2

    • Osteochondritis dissecans

    • Localized articular disorder

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Clinical Findings

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Signs and Symptoms

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  • Pain in 1st metatarsal with walking

  • Decreased extension or dorsiflexion of big toe

  • Pain, redness around joint

  • Callus bunion on top of foot

  • Difficulty finding shoes with proper fit

  • Limited motion of MTP joint

  • Feeling of hard-end during joint motion may indicate bone spur

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Functional Implications

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  • Pain with standing

  • Pain in affected toe with ambulation

  • Inability to wear high-heeled shoes that create extension at big toe

  • Need to wear larger shoes to accommodate bunion

  • Altered gait pattern and mechanical issues of the forefoot; increased supination and external rotation of foot for clearance; forefoot abduction with lateral whip

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Possible Contributing Causes

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  • Abnormal bone structure

  • Rheumatoid arthritis

  • Improper footwear

  • Cast or immobilized foot

  • Osteoarthritis

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Differential Diagnosis

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  • Hallux valgus

  • Rheumatoid arthritis

  • Gout

  • Osteochondrotic lesion of the first metatarsal head

  • Sesamoiditis, turf toe

  • Osteochondritis dissecans

  • Hammer toe

  • Metatarsalgia

  • Metatarsal stress fracture

  • Plantar fasciitis: patient may initially have more pain at medial arch due to altered mechanics before developing significant toe pain

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

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Diagnostic Procedures

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  • Special test for functional hallux limitus

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Findings and Interpretation

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  • Limited joint space

  • Location and size of bone spur

  • Posterior (dorsal) and lateral osteophytes on metatarsal head

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Treatment

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Medication

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  • NSAIDs

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Referrals/Admittance

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  • To hospital for imaging, x-ray

  • To physician for medication, anti-inflammatory, corticosteroid injection

  • To surgeon for surgical consult

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Impairments

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