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  • Stiff big toe
  • Hallux limitus

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  • 735.2 Hallux rigidus

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  • M20.20 Hallux rigidus, unspecified foot

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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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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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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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Imaging

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Diagnostic Procedures

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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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Medication

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  • NSAIDs

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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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  • Antalgic gait secondary to increased supination; rigid hallux may limit pronation of the foot when lower extremity stays straight
  • Antalgic gait secondary to increased pronation from abduction/external rotation of foot, leads patient to collapse at medial arch and pronate further to avoid toe pain
  • Antalgic gait secondary to pain at 1st toe with push-off
  • Hypomobility of MTP joint in big toe
  • Inability to ambulate ...

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