HAV/ Bunion

Dr Information

Summary – Hallux rigidus is one of the most common forms of degenerative joint pathologies of the foot and ankle, representing the end stage arthritis of the 1st metatarsophalangeal joint (MPJ). It is a condition which leads to a reduction in the sagittal plane ROM of the 1st MPJ. Typically the patient will experience most pain upon dorsiflexion of the joint at toe off during the propulsive stage of gait. As the joint experiences arthritic breakdown over time, the body responds by laying down new bone which causes osteophytes to develop limiting the motion through the joint, leading to mechanical impingement, additional cartilage breakdown, osteolysis and eventual ankylosis.
Literature –Perler, A., Nwosu, V., Christie, D., & Higgins, K. (2013). End-Stage Osteoarthritis of the Great Toe/Hallux Rigidus. Clinics in Podiatric Medicine and Surgery, 30(3), 351-395.
Diagnostic tip – Have patient non weight bearing and grasp the medial and lateral aspect of the proximal phalanx of the hallux, whilst stabilising the forefoot attempt to push the the 1st MPJ through dorsiflexion. If little to no ROM is obtained hallux rigidus is present.
Testing or imagery – X-ray- AP, Lat, Lat/Oblique (weightbearing) used to identify osteophytic lipping and uneven joint spaces on the dorsum of the 1st MPJ. MRI and CT scans may be useful for suspicion of osteochondral defects or lesions.
Referrals – Podiatrist may provide shoe modifications, orthotic therapy with or without mortons extensions and padding. If conservative approaches fail orthopaedic surgeons may fuse the joint or conduct a cheilectomy to excise any osteophytes or bone spurs.

Patient Information

Summary – Hallux rigidus is essentially when the big toe joint obtains osteoarthritis and as a result has a reduced range of motion most commonly accompanied by pain. Pain experienced in this big toe joint can make activities such as walking, running, climbing stairs and squatting more difficult as the arthritis develops. You may also feel pain and notice symptoms across the top of your foot as a result of a change in the way you walk by trying to protect the joint from more pain.
How does this occur? – Hallux rigidus develops through degeneration of the big toe joint from arthritis. The arthritis causes the cartilage (cushion between two bones) to wear away and results in bone grinding on bone. The body tries to repair the bone grinding by laying down new bone, however this ends up creating bone spurs which block any joint movement through the big toe.
How can this be helped? – This condition can be treated by a Podiatrist who may provide footwear advice and modification or the use of orthoses to reduce movement through the joint and help prevent the two bones grinding and causing the pain. In more severe cases an orthopaedic surgeon may remove bone spurs or fuse the joint with surgical pins.
Who can help? – Podiatrist and orthopaedic surgeons