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ESSENTIALS OF DIAGNOSIS

ESSENTIALS OF DIAGNOSIS

  • Loss of motion in the first MTP joint.

  • Pain and stiffness in the big toe during activity.

  • Pain and stiffness aggravated by cold weather.

  • Swelling and inflammation around the joint.

  • Hallux rigidus, the end-stage form of hallux limitus, indicates loss of motion of the MTP joint.

GENERAL CONSIDERATIONS

Hallux limitus is a painful, acquired, progressive arthritic condition of the first MTP joint. Hallux limitus occurs in three groups: congenital, adolescents, and adults. Hallux limitus can present unilaterally or bilaterally, but the condition in both feet may not occur at the same stage of arthritis.

Multiple direct and indirect causes of adult hallux limitus have been proposed. Direct mechanisms include trauma, fractures, or turf toe sprains. Indirect forces include biomechanical deformities of the medial column of the foot. Aside from osteoarthritis, various associated factors have been implicated as the etiology of hallux limitus, including inflammatory diseases such as rheumatoid arthritis and gout.

Hallux limitus is a condition that can worsen with time and lead to the condition hallux rigidus. Hallux rigidus, the condition in which there is little or no motion of the big toe joint, is considered to be the end-stage form of hallux limitus.

CLINICAL FINDINGS

A. Symptoms and Signs

The presenting symptoms of hallux limitus are variable and commonly include pain, stiffness, or limited motion of the hallux. The symptoms appear gradually with a deep and achy pain as the most frequent presentation. The degree of discomfort usually correlates with the level of activity such as bending, walking, and standing and tends to progressively increase throughout the day.

Often, the pain and stiffness are exacerbated in cold temperatures. Symptoms vary depending on stage and are aggravated by activity and footwear. Most often the formation of a dorsal bone spur around the big toe joint will lead to direct pressure against the shoe and exacerbate the pain or result in callus formation. In addition, symptoms of paresthesia or neuralgia to the big toe may develop secondary to chronic pressure from the bone spur. Pain is exacerbated by shoe gear that lacks support or drives the big toe joint into dorsiflexion beyond its limited range of motion (ie, high heels or flip flops). Pain, swelling, and crepitus can be encountered in the MTP joint with activity and walking. With time, the mobility of the big toe joint diminishes and dorsiflexion becomes limited.

Most patients exhibit pain to other parts of the body secondary to an altered gait pattern.

B. Imaging

Plain radiographs are used to determine the type and severity of arthritis, but the pain may not coincide with the radiographic findings. Weight-bearing anteroposterior (Figure E5–2A) and lateral views are the most useful ...

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