title: Hallux rigidus.
abstract: Hallux rigidus is a common problem of the first metatarsophalangeal joint and is particularly common in the 31-69 year old age group. Loss of articular cartilage narrowing of joint space and formation of periarticular osteophytes are present and increase over time, often leading to palpable osteophyte formation. The authors suggest that a diagnosis of hallux rigidus be made if at least 4 of the following are present at the big toe: pain, stiffness, palpable exostosis, positive X-ray findings, positive axial grind test, occasional synovitis, decreased motion on motion palpation (particularly dorsiflexion). This case study follows a 36-year-old male professional tennis player over a 7 year period under various forms of management including orthopaedic, physical therapy and chiropractic care. Initial surgery provided some relief, subsequent physiotherapy did not significantly reduce the patient's pain while chiropractic manipulation and mobilization on two separate occasions provided marked reduction in pain scores. NSAID usage and "punching out" his shoes also provided some relief. There is a reasonable possibility that general foot and big toe mobilization and the Brantingham "protective" big toe manipulation may reduce the pain of hallux rigidus. A randomized-controlled study should be done to ascertain the efficacy of such a treatment protocol.
authors.forename: James W
authors.initials: JW
authors.lastname: Brantingham
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Wood
references.citation: J Orthop Sports Phys Ther. 1999 Dec;29(12):727-35
references.pmid: 10612070
references.citation: Foot Ankle Int. 1999 Apr;20(4):232-7
references.pmid: 10229279
references.citation: Foot Ankle. 1980 Jul;1(1):8-10
references.pmid: 6115797
references.citation: Foot Ankle Int. 1999 Dec;20(12):777-80
references.pmid: 10609705
references.citation: Arthroscopy. 1998 Apr;14(3):307-10
references.pmid: 9586978
references.citation: Foot Ankle Int. 1999 Mar;20(3):147-52
references.pmid: 10195291
references.citation: Foot Ankle Int. 1994 Jul;15(7):349-53
references.pmid: 7951968