Figure 22

Figure 23

Figure 24

Hallux rigidus is a degenerative-type arthritis condition that affects the large joint at the base of the great toe. Degenerative arthritis is a condition that results from wear and tear on the joint surface over time. The condition can follow an injury to the joint or, in some cases, can arise without a well-defined injury. (Figure 22: picture of dorsal bunion)

Anatomy

The joint at the base of the great toe is called the metatarsophalangeal or MTP joint. Like any other joint in the body, the joint is covered with articular cartilage, a very slick, shiny covering on the end of the bone. If this material is injured, it begins a slow process of “wearing out” or degeneration. This can result in a wearing away of the articular surface, until raw bone rubs against raw bone.

Bone spurs form around the joint as part of the degenerative process. The spurs may restrict the motion in the joint, especially the ability of the toe to bend upward when the foot moves forward. (Figure 23: picture of dorsal spur)

Symptoms

The degeneration causes two problems: pain and a loss of motion in the MTP joint. Without the ability of the MTP to move enough to allow the foot to roll through while walking, the gait is painful and difficult.

Diagnosis

Diagnosis is usually apparent on examination but x-rays are usually required to determine the extent of the degeneration and the bone spur formation.

Medical treatment

Treatment begins with anti-inflammatory medication to control the inflammation of the degenerative arthritis. Special shoes that reduce the amount of bend in the toe during walking will also help the symptoms initially. A rocker-type sole allows the shoe to take some of the bending force, and may be combined with a metal brace in the sole to limit the flexibility of the sole of the shoe and reduce the motion needed in the MTP joint.

Injection of cortisone into the joint may temporarily relieve symptoms.

Surgery

Surgery may be suggested if all else fails. Several types of procedures are useful in this condition.

Cheilectomy

If less than 50% of the MTP joint is worn out, an operative procedure canned cheilectomy is used to remove only the spur and worn out bone. The integrity of the joint is maintained and the patient has full motion of the joint after the operation. (Figure 24: picture of cheilectomy)

Arthrodesis

Many surgeons favor fusion of the MTP joint to relieve the pain. Arthrodesis results in a joint that no longer moves and a rocker sole shoe is usually necessary to improve the gait following this procedure.

An incision is made into the MTP joint. The joint surfaces of the MTP joint are removed. The two surfaces are then fixed with either a metal pin or screw, with the toe turned slightly upward to allow for walking. The bones are allowed to grow together or fuse. The fusion usually takes about 3 months to become solid.

Arthroplasty

Some surgeons favor replacing the joint with an artificial joint, similar to what is done in the knee or hip, only on a much smaller scale.

In this procedure, one of the joint surfaces is removed and replaced with a plastic surface. This procedure can relieve the pain and preserve the joint motion. The major drawback to this procedure is that the artificial joint probably will not last a lifetime and will require more operations later if it begins to fail. Most surgeons do not recommend this operation.