pain as aching, which is generally made worse
with activity and alleviated with rest [9] . The
motion at the first MTPJ continues to decrease
as the osteoarthritis progresses, which leads to
further osteophyte formation dorsally, medially
and laterally, as well as significant joint space
narrowing.
Patients with symptomatic hallux limitus or
rigidus can be severely restricted in ambulation
due to pain at the first MTPJ. This may cause
them to attempt to walk in a supinated position
(low gear push off), shorten their stride and
avoid propulsion, externally rotate their hip to
push off the medial aspect of the joint, and avoid
performing daily activities of living, decreasing
their quality of life [7] . Treatment options,
therefore, should focus on decreasing pain, and
improving quality of life.
While there are a vast number of surgical
options for hallux limitus/rigidus, there are also
many conservative measures that have been
shown to alleviate pain and prevent further joint
destruction. Conservative treatment options
include shoe modifications, foot orthoses, physical
therapy, oral non-steroidal anti-inflammatory
drugs (NSAIDs), and intra-articular steroid
injections. In one study by Grady et al., over half
of patients with symptomatic hallux limitus were
successfully treated with conservative measures,
and 47% with foot orthoses alone [10] . Further,
the invasiveness of surgical procedures presents
increased risks (e.g. infection, delayed or non-
union, weight transfer to second toe leading to
further pathology) and extended recovery times
for the patient, which can be avoided by the use
of conservative treatments. Therefore, it is often
recommended that surgical measures only be
taken in cases of recalcitrant hallux rigidus.
Figure 2: This radiograph shows changes
at the first MPJ, including joint space
narrowing and early signs of osteophyte
formation consistent with stage 1 or 2
hallux limitus.
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