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Windlass Mechanism

Hallux Rigidus

Hallux rigidus is a condition in which there is no motion available at the first metatarsophalangeal joint (big toe joint). The most common cause of hallux rigidus is osteoarthritis of that joint, often from a history of trauma or biomechanical dysfunction.

The joint that hallux rigidus affects is extremely important for everyday function as we need that joint to pivot at as we move forward. This means that normal walking is severely inhibited by hallux rigidus and it will have a significant impact on normal walking. The body’s own arch support mechanism (the windlass mechanism) is also inhibited as the joint does not move.

The symptoms of hallux rigidus are obvious, as the joint is rigid or almost rigid. There is also often an enlargement on the top of the joint (exostosis) and it can be painful.

The treatment of hallux rigidus is to manage the pain with anti-inflammatory medication and perhaps injections into the joint. Attempts need to be made to facilitate the forward movement that is inhibited with the rigid joint. Often a rocker is added to the bottom of the shoe to help that forward progression. A stiff soled shoe is also used to limit the pressure on the joint to move.

There are a couple of surgical procedures that can be used for hallux rigidus. A cheilectomy is used to remove the dorsal impingement. If the joint needs to be fused to totally eliminate what motion that is left, this is often done with the joint in some degrees of dorsiflexion to allow that forward pivot motion. The other surgical option for hallux rigidus is an artificial joint replacement.


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