Case 2 Hallux Rigidus

Case 2

Hallux Rigidus 

Introduction , Permission to ask questions and examine. Tell patient to remind him if the patient is not comfortable during the examination.

Two Relevant Questions

What happened ?                                            Pain and swelling  elsewhere on body ?

Shoe Wears – Worn outerside of sole

Gait – Liming

Alignment of Great toe – straight

Attitude of Ankle / Lower extremity  - no any particular 

Look foot from Front , Side and Back on standing position

normal skin on dorsum , normal medial arch from side

and no too many toes from back

Callus on medial side of distal phalanx , Skin on dorsum and plantar side is normal

          Ask patient to sit and feet out of bed – see the sole of feet

Feel  - Always first superficially then deep for bony palpation .

Heel ,malleoli , other metarasal bones on feet ,small toes then first metatarsal ,Great toe

 First Metatarsophalnageal joint at last

First Metatarsophalangel joint is knobby , temperature increased , tender dorsal bunion

Palpate Lymph node in popliteal region ,

Movement –                            Restricted Dorsiflexion of toe

Always not to miss comment on LLD – DEVELOP A HABBIT TO THINK ON THIS

Ligamentous Instability          check if it is there

Digital Senstion , Capillary refill to say that the great toe is well perfused and has intact sensory innervation .

Investigations

X-ray – AP , Oblique view of Foot

            Discerns arthritis and  infection from Hallux Rigidus

Treatment

            Not interfering activites of life – Best left alone

            Intermittent Pain –

                                    Intrarticular Injection (Local Anaesthesia and Steroid )

                                    Rock Soled Sholes

                                    Full Length insole

                       

            Severe Pain – Surgery

                                    Chilectomy – Removal of Osteophytes

                                    Extension Osteotomy – Proximal Phalanx

                                    Arthrodesis – 10 degree valgus and dorsiflexion,10 mm clearance

                                    Arthroplasty

                                    Interposition Arthroplasty

                                    Capsular Arthroplasty

                                                Metal implant –better

                                                Silicone implant