Treatment

Hallux rigidus may be treated conservatively or by surgery.

Conservative treatment:

• a rigid metatarsal bar attached to the sole of the shoe takes the strain off the first metatarsophalangeal joint
• cortisone injections can provide relief although this is often short term (1)

Surgical treatment:

• generally divided into two groups (joint-sparing and joint-destructive)
  • debridement of the excessive bone including the dorsal aspect of the metatarsal head (cheilectomy) can be extremely successful
    • option for patients with a rigid joint but pain from the dorsal prominence in shoes alone
    • addition of a dorsiflexion osteotomy of the proximal phalanx of the hallux (Bonney–Kessel procedure) can improve function/reduce discomfort further
  • Keller's operation (Keller's arthroplasty)
    • debridement and resection of the base of the proximal phalanx
    • remains an extremely successful procedure in the right patient
  • arthrodesis
    • effective for pain relief but will limit shoe choice, causes transfer of load to the lateral aspect of the foot and will significantly alter function in those patients that have a degree of motion preoperatively
    • arthrodesis should be performed in slight flexion to accommodate the patient's normal footwear
• replacement of the joint with a silastic spacer may relieve pain and increase the range of dorsiflexion but a foreign body reaction may occur later

Reference:

1. ARC. Common foot disorders. Hands On 2006;10:1-6.