Hallux valgus and rigidus

Red flag screening

• Sinister pathology
• Emergency conditions such as acute tendon rupture or fracture
• Infection/osteomyelitis

Consider

• Mechanism of injury
• Duration and severity in symptoms
• Change in symptoms
• Limitation of function.

Assess passive and active range and quality of motion, bony tenderness, loss of sensation and muscle power.

Hallux rigidus grading system

Grade I: limited motion of the first metatarsophalangeal Joint (MPJ), <350 dorsiflexion.
Mild pain, no significant degenerative joint disease (DJD), minimal osteophyte.
Grade II: limited motion, <200 dorsiflexion, pain, early DJD, osteophyte,
Grade III: limited motion, <100 dorsiflexion.pain
Grade IV: joint ankylosis, <00 dorsiflexion, advanced DJD.

• X-rays
• Bloods if inflammatory condition suspected.

• Pathology with sesamoid; fracture/AVN
• Hallux valgus
• Hallux limitus/rigidus
• Osteomyelitis
• Instability of the joint suggestive of soft tissue/capsule tear
• Inflammatory arthropathy/gout.

• Patient education
• Pain relief/NSAIDs if indicated
• Links to self management
• Advice re activity modification/pacing
• Footwear advice
• Exercise prescription as required.

• Failure of first line treatment
• Ambiguous diagnosis
• Worsening symptoms.