Hallux Rigidus (Arthritis of the First Metatarsophalangeal Joint – MTPJ)
Clinical features
Patients commonly present with:
- Pain and swelling around the big toe joint
- A dorsal bony prominence (“bump”)
- Stiffness with reduced movement, particularly loss of dorsiflexion (upward bending of the toe)
- Difficulty with push-off during walking and problems wearing certain footwear
Imaging
Weight-bearing X-rays typically show:
- Joint space narrowing
- Osteophyte (bony spur) formation
- Joint irregularity consistent with arthritis
Treatment options
Non-operative management
- Footwear modification (stiff-soled or rocker-bottom shoes)
- Activity modification and analgesia
- Corticosteroid injection for temporary pain relief
These measures improve symptoms but do not restore motion or prevent progression.
Surgical options
- Cheilectomy (joint-preserving procedure)
Removal of bony spurs and impinging bone to improve joint clearance.
- Can be performed open or minimally invasive (keyhole-assisted)
- Improves pain and movement in early to moderate arthritis
Does not reverse cartilage wear, therefore arthritis may progress over time
- Arthrodesis (joint fusion — definitive procedure)
The joint is fused in a functional position to eliminate painful motion.
- Reliable long-term pain relief
- Corrects deformity and allows normal walking
- Permanent stiffness of the big toe
- Some footwear and high-impact activities may be limited
This is generally considered the most predictable and durable treatment for advanced arthritis.
- Implant arthroplasty (silicone spacer)
Insertion of a silicone implant to preserve some joint movement.
- Maintains partial motion while relieving pain
- Faster recovery than fusion in selected patients
Potential drawbacks
- Implant loosening or wear
- Rare silicone synovitis (inflammatory reaction)
If the implant fails, the joint can usually be converted to a fusion procedure.
