Managing Hallux Rigidus In The Athlete

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In baseball, the pitcher subjects the hallux of the pivot foot to repetitive microtrauma
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Author(s): 
By Mark A. Caselli, DPM

Hallux rigidus is a painful and insidious condition that can lead to significant limitations in an athlete’s ability to perform. The condition is characterized by a limitation of motion in the first metatarsophalangeal joint (MTPJ), chiefly in the direction of dorsiflexion. This limitation of motion is caused by a reactive proliferation of bone along the dorsal aspect of the joint and is associated with painful, degenerative arthrosis of the first MTPJ.
There are an extensive number of conditions that can result in hallux rigidus (see “A Review Of Potential Hallux Rigidus Etiologies” below). Inflammatory conditions such as gouty, psoriatic or rheumatoid arthritis may lead to symptoms of pain and limitation of motion in the first MTPJ. Longstanding hallux valgus may also be associated with secondary degenerative joint changes.

Hallux rigidus typically presents as an isolated arthritis in the young adult without a systemic arthritic condition. This suggests the degenerative process is caused by some local pathologic alteration in the first MTPJ. Secondary joint degeneration may occur after a recognized traumatic event. Other theories suggest hallux rigidus is caused by extra strain on the first MTPJ in a pronated foot or by an elevated first metatarsal, resulting in a limitation of hallux dorsiflexion. In any case, the condition tends to be progressive.
Keep in mind that radiographic findings may be negative if the condition is early and mild. In more advanced cases, radiography may reveal joint space narrowing, osteophyte formation and loose bodies. Secondary degenerative changes in sesamoids are not uncommon.
Pain about the first MTPJ is the presenting symptom of patients who have hallux rigidus. The patient may or may not be aware of the limitation of joint motion. Given the limitation of dorsiflexion, patients may complain of increased difficulty with activities that require greater dorsiflexion demands, such as walking up an incline, squatting or running. Any activity that requires significant dorsiflexion of the first MTPJ results in painful impingement or jamming. Intolerance of significant heel height is common because of the requisite dorsiflexion of the first MTPJ required to fit into the shoe. You may note swelling around the joint and palpate a dorsal bony proliferation.

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