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Condition/Disorder Synonyms

  • Stiff big toe

  • Hallux limitus

ICD-9-CM Code

  • 735.2 Hallux rigidus

ICD-10-CM Code

  • M20.20 Hallux rigidus, unspecified foot

Preferred Practice Pattern

Key Features


  • 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

Essentials of Diagnosis

  • Diagnosis usually made by clinical examination or x-ray

  • May be independent diagnosis, not associated with disease process

General Considerations

  • Bone spur, osteophyte

  • Swelling

  • Inflammation around joint


  • 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

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • 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

Possible Contributing Causes

  • Abnormal bone structure

  • Rheumatoid arthritis

  • Improper footwear

  • Cast or immobilized foot

  • Osteoarthritis

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis


  • X-ray

Diagnostic Procedures

  • Special test for functional hallux limitus

Findings and Interpretation

  • Limited joint space

  • Location and size of bone spur

  • Posterior (dorsal) and lateral osteophytes on metatarsal head



  • NSAIDs


  • To hospital for imaging, x-ray

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

  • To surgeon for surgical consult



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