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Hallux rigidus 

Hallux rigidus or stiff big toe is degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux (big toe).

Hallux rigidus
Hallux rigidus

Symptoms

There is increasing stiffness and exercise-induced pain around MTP I without preceding trauma, usually affecting adult athletes.

This condition can be mistaken for ‘turf toe’, which is common in young footballers.

Aetiology

The aetiology is unclear but there is a possible genetic predisposition.

Clinical Findings

There is decreased active and passive range of motion, most notably in extension and flexion of the MTP I to the degree that the joint freezes. There is localised swelling, effusion and tenderness on palpation over the MTP I joint. The condition is often bilateral.

Investigations

X-ray is initially normal. In later stages there is typically a decreased joint space, dorsal exostoses and sub-chondral sclerosis.

Treatment

Initially try individually adapted orthotics combined with stretching of the flexor and extensor muscles of MTP I.

NSAID or cortisone injections into MTP I can give short-term relief.

Surgery with osteotomy and excision of exostoses may be indicated to increase the mobility of the joint in severe cases but should be performed with caution on athletes since outcomes are sometimes unpredictable.