Hallux rigidus: A cross-sectional study to evaluate clinical parameters

Abstract

Background Hallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment. Method A cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18–70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions. Results Seventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14–68 years) years and median HR duration 6 years (1–33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found ( r = 0.84, p = 0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI°) was greater than normal (≤10°). A correlation between HAI and reduced 1st MTPJ ROM was found ( r = 0.92, p = 0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found ( r = .78, p = .05). A positive relationship was found between 2nd toe length and 1st MTPJ pain ( p = 0.001 < 0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found ( r = 0.78, p = 0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion ( p < 0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings. Conclusions HR was associated with female gender, bilateral involvement, older age groups, increased HAI°, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.