Understanding Hallux Limitus / Rigidus: A Conservative Approach For Each Stage of Joint Destruction
Surgically, the joint may be fused to decrease all motion
and therefore eliminate pain, or an implant may be used
to essentially replace the joint with better-functioning
parts [14] . possibility for pain and hope to restore a comfortable
ambulatory state for the patient.
Stage 4: Due to the prevalence of this condition among our
patient population, it is crucial to have a simple,
standardized method of classifying, diagnosing, and
treating the various stages of hallux limitus and rigidus.
While there are many, there is currently no classification
system for this deformity that integrates conservative
treatment goals and plans with clinical and radiographic
findings. By proposing an integrated classification
system, we hope to achieve better outcomes with
conservative treatment, prior to considering surgical
options. As physicians, we owe our patients the highest
standard of care, which involves exhausting conservative
approaches before a patient is brought into the operating
room. Implementing these shoe modifications and foot
orthosis prescriptions at each stage of hallux limitus/
rigidus will give our patients the best chance to maintain
their quality of life. -PFA
This stage is similar to the previous stage, except that
any motion at the first MTPJ causes the patient pain.
In this situation, total immobility or replacement of the
joint is warranted. This individual can again be placed
in a rigid, rocker-soled shoe as described above to aid
in keeping this joint immobile. Conservative treatment
at this stage is most likely going to be more of a
temporary fix as the joint auto-fuses, is surgically fused,
or is replaced with an implant. If the patient refuses
surgery and still has pain during ambulation, limiting
forward excursion of the tibia with the use of a molded
ankle foot orthosis (MAFO) may help. The decision
to perform surgery, however, should be based on the
patient’s age, activity level, and overall goals of recovery.
By eliminating motion, we attempt to eliminate the
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Conclusion
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