First Metatarsophalangeal Joint Osteoarthritis – A Clinical Review

The first metatarsophalangeal joint of the human foot may best be classified as an anatomically condyloid synovial juncture. This joint is primarily formed by the rounded head of the first metatarsal bone, in sequence with the shallow concavity of the base of the first proximal phalanx. Whilst there is no dorsal ligament supporting or stabilizing the first metatarsophalangeal joint, the structure is largely secured by both the adjoining collateral ligaments and the plantar metatarsal ligament respectively. The movements permitted at the first metatarsophalangeal joint are inclusive of flexion, extension, abduction and adduction. This articulation is particularly subjected to a significant amount of stress during the weight-bearing activity of human locomotion, and is consequently susceptible to the precipitated development of degenerative osteoarthritis through repetitive loading. Such a pathological sequence can elicit marked intra-articular pain and overall functional limitation capacity of the first metatarsophangeal joint. In reference to the disorder of first metatarsophalangeal joint osteoarthritis, commonly referred to as either hallux limitus or hallux rigidus, this review will scrutinize the differential diagnoses, predisposing factors, physical examination traits and clinical management of the condition accordingly.