Hallux Rigidus: Difference between revisions

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== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


add text here relating to diagnostic tests for the condition<br>Weight bearing, anterior posterior and lateral radiographs are usually needed to examine the joint. Often non-uniform joint space narrowing, widening or flattening of the 1st MT head is seen. Subchondrral sclerosis or cysts, horseshoe shaped osteophytes, lateral greater than medial osteophytes and seasamoid hypertrophy may be seen. A clinical/radiographic grading system was described by Regnauld and appears mainly in the European literature. Hattrup and Johnson (1988) described a radiographic classification which has become standard, and in fact corelates quite
add text here relating to diagnostic tests for the condition<br>Weight bearing, anterior posterior and lateral radiographs are usually needed to examine the joint. Often non-uniform joint space narrowing, widening or flattening of the 1st MT head is seen. Subchondrral sclerosis or cysts, horseshoe shaped osteophytes, lateral greater than medial osteophytes and seasamoid hypertrophy may be seen. A clinical/radiographic grading system was described by Regnauld and appears mainly in the European literature. Hattrup and Johnson (1988) described a radiographic classification which has become standard, and in fact corelates quite&nbsp;well with the Regnauld grading: Grade 1: mild to moderate osteophytes formation but good joint space preservation Grade 2: moderate osteophyte formation with joint space narrowing and subchondral sclerosis Grade 3: marked osteophyte formation and loss of the visible joint space, with or without subchondral cyst formation <br>Coughlin et al (2003) modified the Hattrup and Johnson classification <br>Coughlin and Shurnass classification: <br>• Grade 0: <br>o Dorsiflexion 40-60° <br>o Normal radiography <br>o No pain <br>• Grade 1 <br>o Dorsiflexion 30-40° <br>o Dorsal osteophytes <br>o Minimal/ no other joint changes <br>• Grade 2 <br>o Dorsiflexion 10-30° <br>o Mild to moderate joint narrowing or sclerosis <br>o Osteophytes <br>• Grade 3 <br>o Dorsiflexion less than 10° <br>o Severe radiographic changes <br>o Constant moderate to severe pain at extremities <br>• Grade 4 <br>o Stiff joint <br>o Severe changes with loose bodies and osteochondritis dissecans <br>Examination<br>Look for other features of systemic arthropathy. Assess the overall foot shape, range of ankle dorsiflexion and function of the other foot joints Identify sites of tenderness – is the osteophyte symptomatic? Evaluate the severity of rigidity and the residual arc of movement Is pain provoked mainly by dorsiflexion, plantarflexion or throughout the range of movement? Check the alignment of the great toe, looking for IPJ hyperextension or hallux rigidus with valgus Are there any lesser ray problems? <br>


== Outcome Measures  ==
== Outcome Measures  ==

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Clinically Relevant Anatomy
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add text here relating to clinically relevant anatomy of the condition

Clinical anatomy: The” Big toe”, Great toe or the first metophalangeal joint is where this condition called Hallux rigidus occurs. The base of the the first MTP specifically is where the degenerative arthritis is typically found. The joint is covered with articular cartilage, a shiny covering to protect the bone ends As this covering wears degeneration occurs until bone is against bone. Bone spurs develop as part of this degeneration process and movement is decreased. Normal range of motion is speculated between 65 to 100 degrees. 



Mechanism of Injury / Pathological Process
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add text here relating to the mechanism of injury and/or pathology of the condition
Hallux Rigidus is a progressive disorder. The toe’s motion is decreased over time. Some causes are faulty function or biomechanics and structural abnormalities. Wear and tear over time can lead to osteoarthritis in the joint.

Clinical Presentation[edit | edit source]

add text here relating to the clinical presentation of the condition
Pain, stiffness and loss of motion are the some signs of hallux rigidtus. Burning pain and parasthesia can be present. Walking, standing and wearing heels aggravate the pain. Symptoms are relieved by rest.
The normal dorsiflexion range of motion of the first MPJ is at least 65 degrees by Root, et al., many other authors (Joseph, Buell, Bojsen-Moller, Hetherington) Nawoczenski, et al. showed a new standard of “normal” range of dorsiflexion range of motion of the great toe joint should now be set at approximately 45 degrees. However, this dorsiflexion range has only been verified for walking gait, not running.

Diagnostic Procedures[edit | edit source]

add text here relating to diagnostic tests for the condition
Weight bearing, anterior posterior and lateral radiographs are usually needed to examine the joint. Often non-uniform joint space narrowing, widening or flattening of the 1st MT head is seen. Subchondrral sclerosis or cysts, horseshoe shaped osteophytes, lateral greater than medial osteophytes and seasamoid hypertrophy may be seen. A clinical/radiographic grading system was described by Regnauld and appears mainly in the European literature. Hattrup and Johnson (1988) described a radiographic classification which has become standard, and in fact corelates quite well with the Regnauld grading: Grade 1: mild to moderate osteophytes formation but good joint space preservation Grade 2: moderate osteophyte formation with joint space narrowing and subchondral sclerosis Grade 3: marked osteophyte formation and loss of the visible joint space, with or without subchondral cyst formation
Coughlin et al (2003) modified the Hattrup and Johnson classification
Coughlin and Shurnass classification:
• Grade 0:
o Dorsiflexion 40-60°
o Normal radiography
o No pain
• Grade 1
o Dorsiflexion 30-40°
o Dorsal osteophytes
o Minimal/ no other joint changes
• Grade 2
o Dorsiflexion 10-30°
o Mild to moderate joint narrowing or sclerosis
o Osteophytes
• Grade 3
o Dorsiflexion less than 10°
o Severe radiographic changes
o Constant moderate to severe pain at extremities
• Grade 4
o Stiff joint
o Severe changes with loose bodies and osteochondritis dissecans
Examination
Look for other features of systemic arthropathy. Assess the overall foot shape, range of ankle dorsiflexion and function of the other foot joints Identify sites of tenderness – is the osteophyte symptomatic? Evaluate the severity of rigidity and the residual arc of movement Is pain provoked mainly by dorsiflexion, plantarflexion or throughout the range of movement? Check the alignment of the great toe, looking for IPJ hyperextension or hallux rigidus with valgus Are there any lesser ray problems?

Outcome Measures[edit | edit source]

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Management / Interventions
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Differential Diagnosis
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Key Evidence[edit | edit source]

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Resources
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Case Studies[edit | edit source]

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References[edit | edit source]

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