Hallux Rigidus
What is it: Hallux Rigidus is generally caused by arthritis of the first metatarsal phalangeal joint that causes pain and stiffness of the great toe at that joint.
How does it present: Patient usually complain of pain at the first MTP joint, especially with the "push off" phase of walking. They may also have pain with trying to flex and extend the great toe or may find that the toe is still and unable to move well.
Common exam findings: Exam findings include tenderness to palpation over the first MTP. Pain may also be elicited with passive flexion and extension or they may have decreased range of motion.
Tests and treatment: Foot and toe x-rays may be helpful in making this diagnosis by evaluating for the arthritis. Treatment is initially conservative. Wearing shoes with a wide toe box may be helpful. In addition, stiff soled shoes may help decrease the flexion/extension of the toe with walking and decrease pain. In some cases a rocker bottom shoe or orthotic with a steel plate to decrease movement in this joint when walking may be helpful. In some cases a steroid injection into the joint may help alleviate some pain. In more severe cases, surgical intervention may be necessary to alleviate pain.