Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Hallux Rigidus

SYMPTOMS

There is increasing stiffness and exercise-induced pain around MTP I without preceding trauma, usually affecting adult athletes. This condition can be mistaken for ‘turf toe’, which is common in young footballers.

AETIOLOGY

The aetiology is unclear but there is a possible genetic predisposition.

CLINICAL FINDINGS

There is decreased active and passive range of motion, most notably in extension and flexion of the MTP I to the degree that the joint freezes. There is localised swelling, effusion and tenderness on palpation over the MTP I joint. The condition is often bilateral.

INVESTIGATIONS

X-ray is initially normal. In later stages there is typically a decreased joint space, dorsal exostoses and sub-chondral sclerosis.

TREATMENT

Initially try individually adapted orthotics combined with stretching of the flexor and extensor muscles of MTP I. NSAID or cortisone injections into MTP I can give short-term relief. Surgery with osteotomy and excision of exostoses may be indicated to increase the mobility of the joint in severe cases but should be performed with caution on athletes since outcomes are sometimes unpredictable. Full weight bearing is usually allowed within six weeks of surgery.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if there are severe or progressive symptoms.

EXERCISE PRESCRIPTION

Rest will not help, so allow all kinds of sporting activities using well-fitting shoes. If there is pain on impact, suggest cycling, swimming or other low-impact sports as alternatives to running and jumping.

DIFFERENTIAL DIAGNOSES

Osteoarthritis, which usually does not give the typical stiffness and X-ray appearance; turf toe, which is post-traumatic intra-articular stiffness due to capsule and cartilage damage.

EVALUATION OF TREATMENT OUTCOMES

Monitor decreased clinical symptoms and signs and expect a normal X-ray around 12 weeks from surgery.

PROGNOSIS

Good-Fair. Many of these conditions lead to an immovable joint, in the long term preventing running and jumping on the forefoot.

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