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Hallux rigidus: another form of "onion"

Another form of the "bunion" of the foot: the Hallux Rigidus (rigid big toe)

In this case, the big toe does not deviate, but it becomes more and more painful when walking, because upward flexion (dorsiflexion) is limited.

Dorsiflexion normal

Limited dorsal flexion

It is in fact an osteoarthritis between the first phalanx of the big toe and the first metatarsal, with the formation of bony beaks which mechanically limit movement.

HR rx pre.jpg


- at the beginning: wide front shoes with a rigid sole, so that the toe has to bend less upwards when walking.

Examples: MBT shoes (very expensive) or Sketchers (cheaper)

- at the more advanced stage, when adequate footwear is no longer sufficient, surgery must be discussed.


Hallux Rigidus Operations:

1. Joint release and realignment of the phalanx (cheilectomy with Moberg osteotomy)

When there is articular cartilage remaining, but the bony spurs interfere with walking, the joint can be preserved: we limit ourselves to resecting the bony spurs:

Sometimes it is necessary to add an upward realignment of the basal phalanx of the big toe: Moberg's osteotomy:

A wedge of dorsal bone is removed with a saw, and by closing this gap, an upward realignment (extension) of the phalanx is caused. The phalanx is then fixed in the new position by a small titanium screw which remains permanently.

This realignment further improves the unfolding of the step and therefore the ease of walking.  


2. Arthrodesis (blocking of the big toe, fusion of the phalanx with the metatarsal)

When there is no more cartilage left, we can discuss doing an arthrodesis, or fusion between the metatarsal and the phalanx: this operation has the advantage of effectively eliminating pain and being definitive; on the other hand, it involves a complete blockage of the joint. Bone fusion must be complete and of good quality. In smokers or people with poor blood circulation, there is a risk that this may not be the case.

It is necessary to count with a cast immobilization of 2 months in partial load.

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