Hallux Rigidus Anatomy and Pathology

The anatomy of the hallux MTP is an intricate complex that facilitates well-coordinated movements throughout gait and athletic activities. Although the signs, symptoms, and presentation of hallux rigidus are nearly universally recognized, significant debate remains as to the specific cause and causative risk factors of disease development. The presentation of hallux rigidus is consistent in the literature including pain, swelling, limited range of motion asymmetrically affecting dorsiflexion, and dorsal osteophytes. Radiographically, this presents with flattening of the metatarsal head, loss of joint space, and dorsal osteophytes. Predisposing patient historical factors including trauma and family history are frequently present, correlating with unilateral and bilateral disease, respectively. Clinical and radiographic findings, including inflammatory arthropathy, flattened or chevron metatarsal head morphology, presence of osteochondral lesions, and HVI, seem to have general acceptance of correlation with disease. However, other factors, including first ray hypermobility, pes planus, equinus contracture, metatarsal length, metatarsus adductus, equinus contracture, FHL pathologic condition, and MPE remain topics of debate that perhaps will be better elucidated with emerging technologies such as WBCT.