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  • Stiff big toe

  • Hallux limitus


  • 735.2 Hallux rigidus


  • M20.20 Hallux rigidus, unspecified foot


  • 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

Essentials of Diagnosis

  • Diagnosis usually made by clinical examination or x-ray

  • May be independent diagnosis, not associated with disease process

  • Classification2

    • 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

General Considerations

  • Bone spur, osteophyte

  • Swelling

  • Inflammation around joint

FIGURE 209-1

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. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

FIGURE 209-2

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. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)


  • Adults

    • Generalized degenerative arthritis

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

    • Dancers at higher risk

    • Most common form of arthritis in foot

  • Adolescents3

    • Osteochondritis dissecans

    • Localized articular disorder



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