# Hallux Rigidus

> NEET-PG Orthopaedics hallux rigidus covers first MTP osteoarthritis, the dorsal osteophyte, Coughlin grading and cheilectomy versus first MTP fusion.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/hallux-rigidus
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-15
- Last updated: 2026-10-15
- Reference basis: Campbell's Operative Orthopaedics; Maheshwari's Essential Orthopaedics; Apley's System of Orthopaedics and Fractures
- How to cite: "Hallux Rigidus", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/hallux-rigidus

## Direct answer

Hallux rigidus is degenerative osteoarthritis of the first metatarsophalangeal joint, causing progressive pain and loss of dorsiflexion of the great toe. A dorsal osteophyte on the metatarsal head is its hallmark, and it impinges on the joint during push-off. Early disease is managed with stiff-soled footwear and a rocker-bottom sole, while cheilectomy or first MTP fusion is used when conservative care fails.

## What you must remember

- **Hallux limitus:** the early, mechanical stage in which dorsiflexion is restricted but the joint has little or no arthritic change.
- **Aetiology:** mostly primary degenerative change, though trauma, gout and an abnormal first metatarsal can contribute.
- **Symptoms:** pain on push-off, stiffness, and swelling around the first MTP joint, with the toe unable to dorsiflex normally.
- **Dorsal osteophyte:** the radiographic hallmark on the lateral view, which impinges during extreme dorsiflexion.
- **Coughlin grading:** the Coughlin and Shurnas system stages disease from mild, with a small osteophyte and preserved joint space, to severe, with extensive joint space loss, and textbooks differ in exact criteria.
- **Cheilectomy:** excision of the dorsal osteophyte and joint debridement, which preserves motion and suits early to moderate disease.
- **First MTP fusion:** arthrodesis in a functional position, used for advanced disease, at the cost of loss of joint motion.

## Choosing the operation for hallux rigidus

The choice of treatment depends on how much joint space remains and on how active the patient is. The table compares the options usually discussed in the exam, and it shows why motion is the main trade-off.

| Option | Usual indication | Preserves motion? |
|---|---|---|
| Shoe modification | Early disease with tolerable pain | Yes, but does not change the disease |
| Cheilectomy | Early to moderate disease with preserved joint space | Yes, with less dorsiflexion gained once arthritis is advanced |
| First MTP fusion | Advanced disease with loss of joint space | No, the joint becomes fixed |
| Implant arthroplasty | Selected patients, with variable outcomes | Partial, used less often in active patients |

Shoe modification comes first in almost every case, with stiff soles, a rocker-bottom profile and orthoses. The table is a summary of the usual choices, and the exact operation is decided by clinical examination and the radiographic grade. A useful habit in the exam is to ask whether joint space is still visible on the weight-bearing radiograph, because that single finding usually separates cheilectomy from fusion.

## Where the exam tries to catch you

Hallux rigidus questions reward the link between joint space, motion and the operation chosen.

- **Trap:** performing a first MTP fusion for early disease with a preserved joint space. **Correct:** cheilectomy preserves motion, and fusion is reserved for advanced disease with loss of joint space.
- **Trap:** attributing the stiffness to hallux valgus. **Correct:** hallux rigidus is degenerative joint disease with loss of dorsiflexion, whereas hallux valgus is lateral deviation of the toe.
- **Trap:** believing that removing the osteophyte is enough in advanced disease. **Correct:** once joint space is lost, cheilectomy gives less benefit, and fusion is more reliable for pain relief.

## Frequently asked questions

### Which radiographic sign is characteristic of hallux rigidus?

The dorsal osteophyte on the first metatarsal head is the characteristic radiographic sign of hallux rigidus. It is best seen on the lateral radiograph, and it impinges during dorsiflexion. Joint space narrowing and subchondral changes are seen in more advanced disease.

### What is the difference between hallux rigidus and hallux limitus?

Hallux limitus is the early, mechanical stage of first MTP disease, in which dorsiflexion is restricted without much arthritic change. Hallux rigidus is the later stage, with established osteoarthritis, osteophyte formation and pain. The two lie on a spectrum, and the distinction is made by radiographs and the degree of stiffness.

### When is cheilectomy preferred over first MTP fusion for hallux rigidus?

Cheilectomy is preferred over first MTP fusion for hallux rigidus when joint space is preserved and disease is early to moderate. It removes the impinging osteophyte and keeps the joint mobile. Fusion is reserved for advanced disease where the joint space has been lost.

### Which footwear modifications help hallux rigidus?

Stiff-soled shoes, a rocker-bottom sole and custom orthoses help hallux rigidus by limiting dorsiflexion of the first MTP joint during walking. These measures reduce pain without changing the underlying disease. They are the first-line treatment in early and moderate disease.