1st MTPJ Osteoarthritis / Hallux Rigidus
- 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.
- 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.
Initial management should include;
- Patient education
- Recommend stiffer soled shoes
- 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.