Hallux limitus and rigidus are a spectrum of a disease involving progressive degeneration of the first metatarsophalangeal joint (MTPJ). There are multiple causes known to cause this condition, from biomechanical (elevated first metatarsal, elongated first metatarsal, etc.) to medical (gout, rheumatoid arthritis, infections, etc.)

As a surgeon, I have to determine the condition of the joint at the time of presentation and the symptoms patients relate. Not all radiographically destroyed joints are symptomatic, and not all radiographically normal joints have mild symptoms. There is a spectrum of disease that has to be carefully evaluated against the conservative and surgical options available.

Simple procedures like cheilectomy can buy time. Decompression osteotomies can do the same thing. However, if the joint degeneration is fairly advanced, the only likely outcome is secondary procedures. This is because the surgeon chose a procedure that increases painful motion.

If a joint has undergone degeneration 'past the point of no return,' joint destructive procedures must be employed. This includes arthroplasty and arthrodesis. The former involves removing part of the joint, the latter meaning fusion or permanent removal and stiffening of the joint.

In my experience, preservation of sagittal plane dominant joints (first MTPJ, ankle, knee) is critical to undisturbed gait. Therefore all measures should be explored before fusing these joints. Many patient have been referred in because they were given the only option of fusing the great toe joint. This is often not necessary, as implant arthroplasty has excellent long term survival rates in the right population and if performed technically well.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.