Current concepts review: hallux rigidus.

Hallux rigidus refers to degenerative arthritis of the first metatarsophalangeal (MTP) joint. Although Davies-Colley provided the first description of the condition in 1887, Cotterill coined the term hallux rigidus to characterize the painful limitation of motion at the first MTP joint.15,18 After hallux valgus, it is the most common affliction of the great toe and the most common form of degenerative joint disease in the foot.34 A wide spectrum of options is available for the treatment of hallux rigidus, although current literature emphasizes surgical intervention, ranging from simple cheilectomy to more complex osteotomies and joint arthroplasty. Considerable controversy surrounds several of these procedures regarding their indications and outcomes. Moreover, one must be mindful of the variability in natural history of hallux rigidus. In some cases, the condition takes a relatively benign course without a progression of symptoms. Smith and colleagues reported on a small series of symptomatic patients treated nonoperatively for duration of 12 to 19 years80 (Level IV evidence). Although 67% of patients showed measurable loss of cartilage space radiographically over time, only 1 of 22 patients reported worsening of their pain. Nearly 75% of the cohort stated that they would still choose nonoperative treatment at latest followup. The abundance of options combined with the uncertainty of their outcomes renders clinical decision-making challenging. This review will evaluate the broad array of nonoperative and operative alternatives currently available for the management of hallux rigidus.