Hallux Limitus and Rigidus Overview

Study Notes

Hallux Limitus and Rigidus Definitions

Hallux Limitus involves decreased range of motion of the first metatarsophalangeal joint (MPJ) to less than 65° in the sagittal plane, resulting in pain.
Hallux Rigidus is characterized by absent motion at the first MPJ.

Normal Gait Requirements

Normal gait requires dorsiflexion of 65°-75° at the first MPJ.

Types of Hallux Limitus

Functional Hallux Limitus presents decreased MPJ motion under load, often showing pain or limited motion in weightbearing stance, and responds well to orthosis.
Structural Hallux Limitus demonstrates decreased hallux motion regardless of foot loading, often due to bony overgrowth or loss of joint surface.

Etiology of Hallux Limitus/Rigidus

Contributing factors include a long or immobile first ray, 1st ray elevatus, degenerative joint disease (DJD), septic arthritis, systemic arthritides, trauma, and sometimes iatrogenic causes.

Regnauld Classification of Hallux Limitus

Grade I: Functional limitations and mild dorsal spurring without structural sesamoid disease.
Grade II: Features a broad, flat metatarsal head with narrow joint space and sesamoid hypertrophy.
Grade III: Severe joint space loss, extensive spurring, and osteochondral defects.

Olaff Jacobs Classification Stages

Stage 1: NWB less than 65° and WB less than 30° dorsiflexion; pain during ROM without crepitus.
Stage 2: NWB ROM < 50-64° and pain with ROM; mild degenerative changes.
Stage 3: NWB ROM < 30-45° and pain with crepitus; moderate degenerative changes.
Stage 4: NWB ROM < 20°; absent ROM on WB, pain, crepitus, and severe degenerative changes.

ACFAS Classification of Hallux Limitus

Grade 1: Biomechanical imbalance with metatarsal elevation but no joint disease.
Grade 2: Early disease with dorsal spurring.
Grade 3: Moderate disease indicated by spur formation and joint space narrowing.
Grade 4: End-stage condition.

Clinical Presentation of Hallux Limitus/Rigidus

Symptoms include joint pain with palpation and ROM, palpable exostosis, 1st ray elevation, metatarsalgia, and signs of arthritis.

Radiographic Findings

Common findings include flattening of the first metatarsal head, dorsal exostosis, joint space narrowing, and the presence of loose bodies.

Conservative Treatment Options

Non-steroidal anti-inflammatory drugs (NSAIDs), injections, physical therapy, and orthosis like Morton's extension are recommended.

Surgical Considerations

Joint salvage treatments apply to Hallux Limitus stages 1-3, aiming to alleviate pain, regain motion, and ensure long-term results. Joint destruction is indicated for Hallux Rigidus.

Joint Salvage Procedures

Cheilectomy: The most common procedure involving shaving off bone and removing dorsal exostosis.
Austin procedure: Shortening osteotomy balancing metatarsal shortening with slight dorsiflexion.
Hohmann: A trapezoidal wedge method, less frequently utilized.
Waterman: Dorsiflexory wedge procedure that protects the sesamoids; modifications allow for greater correction.

Miscellaneous

Kessel and Bonney procedure: Focuses on a dorsiflexed hallux, refining the understanding and treatment approaches for hallux conditions.

Description

Test your knowledge on Hallux Limitus and Rigidus, including definitions, types, and etiology. Learn about the implications on normal gait and the Regnauld classification. This quiz covers the essential aspects related to these common foot conditions.