Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Stiff big toeHallux limitus ++ 735.2 Hallux rigidus ++ M20.20 Hallux rigidus, unspecified foot ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1 +++ Description ++ Stiff big toe or rigid 1st rayArthritic degeneration of great toe (hallux) Progression to bone spurs at 1st metatarsophalangeal (MTP) joint Limited MTP joint mobilityBump or callus on MTP jointAltered mechanics during push-off phase of gait +++ Essentials of Diagnosis ++ Diagnosis usually made by clinical examination or x-rayMay be independent diagnosis, not associated with disease process +++ General Considerations ++ Bone spur, osteophyteSwellingInflammation around joint +++ Demographics ++ AdultsGeneralized degenerative arthritisPoor footwear: improper fit, pointed toe, narrow forefootDancers at higher riskMost common form of arthritis in footAdolescents2Osteochondritis dissecansLocalized articular disorder +++ Signs and Symptoms ++ Pain in 1st metatarsal with walkingDecreased extension or dorsiflexion of big toePain, redness around joint Callus bunion on top of footDifficulty finding shoes with proper fitLimited motion of MTP jointFeeling of hard-end during joint motion may indicate bone spur +++ Functional Implications ++ Pain with standingPain in affected toe with ambulationInability to wear high-heeled shoes that create extension at big toeNeed to wear larger shoes to accommodate bunionAltered 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 structureRheumatoid arthritisImproper footwearCast or immobilized footOsteoarthritis +++ Differential Diagnosis ++ Hallux valgusRheumatoid arthritisGoutOsteochondrotic lesion of the first metatarsal headSesamoiditis, turf toeOsteochondritis dissecansHammer toeMetatarsalgiaMetatarsal stress fracturePlantar fasciitis: patient may initially have more pain at medial arch due to altered mechanics before developing significant toe pain +++ Imaging ++ X-ray +++ Diagnostic Procedures ++ Special test for functional hallux limitus ++ Limited joint spaceLocation and size of bone spurPosterior (dorsal) and lateral osteophytes on metatarsal head +++ Medication ++ NSAIDs ++ To hospital for imaging, x-rayTo physician for medication, anti-inflammatory, corticosteroid injectionTo surgeon for surgical consult ++ 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 painAntalgic gait secondary to pain at 1st toe with ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.