1st MTPJ Osteoarthritis / Hallux Rigidus

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Patient Information

https://matthewwelck.com/wp-content/uploads/2019/12/big-toearthritis.pdf

https://www.bofas.org.uk/Patient-Information/Hallux-rigidus

GP Information

Background Information

  • A common condition in adults secondary to degenerative arthritis.
  • Patients typically complain of swelling, stiffness and pain in the hallux (big toe) MTPJ and first ray. Nerve compression from tight shoes may cause paresthesia.
  • Examination may reveal limited dorsiflexion at the hallux MTPJ with a positive hallux grind test.

Investigation Guidelines

  • A weight bearing XR of the hallux MTPJ is appropriate if considering surgery but not required for referral.
  • Blood tests are indicated if suspicion of crystal arthropathy.

Management Recommendations

Initial management should include;

  • Analgesics
  • Patient education
  • Recommend stiffer soled shoes

Referral Indications

  • Persistent pain despite shoe-wear modification and conservative measures of a minimum 3 months duration.
  • Increasing deformity with difficulty in finding fitting shoes.
  • New pain elsewhere in the foot due to altered biomechanics.
  • Surgical options include cheilectomy, injection, fusion, replacement, interposition.