Skip to content

Clinicians › Foot

Hallux rigidus

32 citationsUpdated Oct 2026
Illustration: foot

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint [5]. This condition is often associated with a mechanical block resulting from periarticular osteophytes [5]. Patients with hallux rigidus demonstrate sagittal plane range of motion limitations in the hallux compared to controls [6]. Additionally, these patients exhibit a prolonged stance phase relative to healthy individuals [6].

Plantar pressure distribution findings in older people with osteoarthritis of the first metatarsophalangeal joint are consistent with theoretical models of foot function [4]. These biomechanical observations may explain the development of secondary changes associated with hallux limitus and rigidus [4]. The reliability and validity of current grading criteria for hallux rigidus may require further exploration [2].

Anatomy & Pathophysiology

Definition and Epidemiology

Hallux rigidus is defined as arthrosis of the first metatarsophalangeal (MTP) joint, characterized by restriction of motion at this articulation [44] [35]. The condition frequently affects patients from their thirties onward, a younger demographic than typical arthritis of other joints [35], though it is far more common in older adults and can rarely occur in adolescents [44]. Epidemiologically, hallux rigidus is frequently bilateral [44] and associated with female gender [35], with girls affected more often than boys [44]. A positive family history is common and associated with bilateral involvement [44] [35]. The condition is also associated with hallux valgus interphalangeus [35]. Conversely, hallux rigidus is not associated with elevatus, first ray hypermobility, a long first metatarsal, Achilles tightness, abnormal foot posture, symptomatic hallux valgus, adolescent onset, shoe wear, or occupation [35].

Etiology and Pathogenesis

The etiology of hallux rigidus in younger patients remains unclear but may be associated with unrecognized chondral injury to the metatarsal head [35]. Several theories regarding pathogenesis have been proposed, including repetitive trauma, a hypermobile long first ray, osteochondritis dissecans, and plantar contracture [44]. Dysfunction of the windlass mechanism is associated with the condition [47]. Biomechanical analysis reveals that patients with hallux rigidus demonstrate significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet [47].

Clinical Presentation and Biomechanics

Patients primarily complain of pain in the first MTP joint, which is exacerbated by weight bearing and sports activities [35]. Discomfort is greatest during heel rise because the great toe normally dorsiflexes at this time [44]. A dorsal eminence may prevent shoewear and is often accompanied by swelling and redness [35]. Physical examination reveals painful limitation in dorsiflexion of the first MTP joint, with dorsiflexion lost before plantar flexion [44]. A palpable osteophyte is often present on the dorsum of the joint [44]. The base of the metatarsal appears more plantar than normal, and the metatarsal head is elevated [44]. Patients typically walk on the lateral border of the feet to avoid rolling over the great toe [44]. Gait analysis demonstrates a prolonged stance phase and sagittal plane range-of-motion limitations in the hallux compared to controls [6]. Preoperative altered hallux and forefoot positions shift towards normal after cheilectomy [18].

Radiographic Findings

Weight-bearing radiographs demonstrate arthritic changes including loss of joint space, subchondral sclerosis, and osteophytes [35]. Osteophytes are especially present on the dorsal aspect of the metatarsal neck [35]. Lateral plain films can demonstrate dorsal osteophytes at the base of the proximal phalanx and metatarsal head [44]. Exostoses may become quite large and obscure visualization of the joint itself [44]. Osteochondritic lesions of the metatarsal head can be seen in young patients [44].

Joint Kinematics and Motion Analysis

In normal specimens, instant centers of rotation for the first MTP joint fall within the head of the first metatarsal [15]. Normal surface motion consists of minor distraction during early plantar flexion, followed by tangential sliding throughout the rest of motion [15]. In contrast, feet with hallux valgus display variable instant centers of rotation and surface-velocity vectors, characterized by early distraction, some sliding, and late compression [15]. Specimens with hallux rigidus reveal displaced instant centers of rotation for sesamoid motion [15]. Compression of the joint surfaces is present throughout the arc of motion in specimens with hallux rigidus [15].

Classification

Hallux rigidus is defined as a progressive osteophytic degeneration of the first metatarsophalangeal joint, characterized by restriction of motion often associated with mechanical block from periarticular osteophytes [5]. This condition is more common in individuals above the age of 50 years [50].

Modified Grading System: A grading system was modified to add a Grade 4 for advanced disease and a Grade 0 for asymptomatic patients with early loss of metatarsophalangeal joint motion [33]. This system incorporates elements of prior grading systems and requires both subjective and objective examination and radiographic data to determine the grade [33]. When applied retrospectively, the modified grading system correctly predicted a successful outcome in 108 of 110 patients [33]. It accurately predicted a fair or poor outcome in patients with Grade-4 hallux rigidus treated with cheilectomy [33]. Cheilectomy uniformly failed in patients with Grade-4 hallux rigidus, as predicted by the grading system [33]. Five of the nine feet with Grade-4 hallux rigidus treated with cheilectomy subsequently underwent arthrodesis [33]. Two of the four remaining patients with Grade-4 hallux rigidus treated with cheilectomy had moderate to severe metatarsophalangeal joint pain with a mean pain score of 4.4 points [33]. Cheilectomy unexpectedly failed in two of thirty-four patients with Grade-3 hallux rigidus [33]. Both patients with Grade-3 hallux rigidus in whom cheilectomy failed had radiographic evidence of chondrolysis within one year after surgery [33]. The two patients with Grade-3 hallux rigidus in whom cheilectomy failed subsequently underwent arthrodesis at seven and eight years following the initial procedure [33].

Standard Grading Tiers: Hallux rigidus is graded as Grade 0 (normal), Grade 1 (preservation of joint space, mild osteophyte formation), Grade 2 (mild to moderate joint-space narrowing, moderate osteophyte formation, subchondral sclerosis and cysts), and Grade 3 (severe joint-space narrowing, significant osteophyte formation, loose bodies, subchondral sclerosis and cysts) [61].

Clinical Presentation

Epidemiology and Risk Factors

Hallux rigidus presents in patients from their thirties onward [35], though it is far more common in older adults and rarely occurs in adolescents [44]. The condition affects girls more often than boys and is frequently bilateral [44]. Associated risk factors include hallux valgus interphalangeus, female gender, and a family history of bilateral involvement [35]. In a Japanese village study, the prevalence among individuals over 50 years old was 26.7% [61]. Knee osteoarthritis (KOA), hallux valgus (HV), and gout (GA) are independent risk factors for the condition [61]. Furthermore, KOA is significantly associated with disease severity, with patients having KOA more likely to present with severe hallux rigidus [61].

Symptoms and History

Patients primarily complain of pain in the first metatarsophalangeal joint, particularly during extension [35]. Initial symptoms consist mainly of pain during gait [44]. Discomfort is greatest during heel rise, as the great toe normally dorsiflexes at this phase [44]. Weight bearing and sports activities exacerbate the pain [35]. A dorsal eminence may develop, preventing shoewear and associated with swelling and redness [35].

Physical Examination

Inspection: Observation of gait reveals that patients walk on the lateral border of the feet to avoid rolling over the great toe [44]. The base of the metatarsal appears more plantar than normal, and the metatarsal head is elevated [44].

Palpation: There is often a palpable osteophyte on the dorsum of the joint, and swelling may be present [44].

Range of Motion: Physical examination reveals painful limitation in dorsiflexion of the first metatarsophalangeal joint [44]. Dorsiflexion is lost before plantar flexion [44]. Patients demonstrate sagittal plane range of motion limitations in the hallux compared to controls [6].

Special Tests and Biomechanics: Dysfunction of the windlass mechanism is associated with hallux rigidus, evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion [47].

Imaging

Weight-bearing radiographs of the foot demonstrate arthritic changes, including loss of joint space, subchondral sclerosis, and the presence of osteophytes [35]. Osteophytes are especially present on the dorsal aspect of the metatarsal neck [35]. Lateral plain films can demonstrate dorsal osteophytes at the base of the proximal phalanx and metatarsal head [44]. Exostoses may become quite large and obscure visualization of the joint itself [44]. In young patients, osteochondritic lesions of the metatarsal head can be seen [44].

Biomechanical Assessment

In specimens with hallux rigidus, sesamoid motion revealed displaced instant centers of rotation [15]. Altered hallux and forefoot positions preoperatively showed shifts towards normal after cheilectomy [18]. Plantar pressure distribution findings in older people with osteoarthritis of the first metatarsophalangeal joint are consistent with theoretical models of foot function and may explain the development of secondary changes associated with hallux limitus/rigidus [4].

Grading and Prognostic Assessment

A grading system incorporating subjective and objective examination and radiographic data correctly predicted a successful outcome in 108 of 110 patients when applied retrospectively [33]. This system accurately predicted a fair or poor outcome in patients with Grade-4 hallux rigidus treated with cheilectomy [33]. Five of the nine feet in which Grade-4 hallux rigidus was treated with cheilectomy subsequently had an arthrodesis [33]. Both patients with Grade-3 hallux rigidus who had failed cheilectomy had radiographic evidence of chondrolysis within one year after the surgery [33]. These two patients subsequently underwent arthrodesis of the metatarsophalangeal joint at seven and eight years following the cheilectomy [33].

Investigations

Plain radiography: Weight-bearing radiographs of the foot are the primary imaging modality for demonstrating arthritic changes in hallux rigidus [35]. These images reveal loss of joint space, subchondral sclerosis, and osteophytes, with particular prominence on the dorsal aspect of the metatarsal neck [35].

CT: Weight-bearing CT scans better demonstrate the true orientation of bones and joints during loading compared to standard imaging [64]. This modality aids in the diagnosis and preoperative planning of complex foot and ankle pathologies [64]. Because foot alignment changes with loading, it is important to measure bone positions in controlled conditions [40].

Biomechanical and Kinematic Assessment: Patients with hallux rigidus demonstrate a prolonged stance phase and sagittal plane range of motion limitations in the hallux compared to controls [6]. In specimens with hallux rigidus, sesamoid motion reveals displaced instant centers of rotation, and compression of the joint surfaces is present throughout the arc of motion [15].

Clinical and Functional Assessment: Patients primarily complain of pain in the first metatarsophalangeal joint, especially with extension [35]. The dorsal eminence may prevent shoewear and is associated with swelling and redness [35]. Weight bearing and sports activities exacerbate the pain [35].

Treatment

Non-Operative

Conservative management for hallux rigidus initiates with nonsteroidal anti-inflammatory drugs (NSAIDs) and shoe modifications [35]. Recommended footwear includes a stiff-soled shoe with a deep toe box to relieve dorsal rubbing, a rigid shank to limit metatarsophalangeal (MTP) joint motion at heel rise, and a stiff insert extending medially past the MTP joint [35, 44]. A rocker-bottom shoe assists with push-off, while orthotic devices featuring a Morton’s extension or carbon fiber plate provide additional support [35, 44, 51]. In older (>60 years), sedentary patients, these conservative measures are usually adequate [35].

Operative

Indications: Surgical intervention is indicated for symptomatic grade 1 or 2 hallux rigidus recalcitrant to conservative treatment [1]. Early to mid-stage disease is best managed with joint-preserving procedures, while arthrodesis and arthroplasty are reserved for late-stage hallux rigidus [17]. Arthrodesis is specifically recommended for young, active patients with advanced cases who remain functionally limited after other treatments have failed [44]. Cheilectomy is indicated for mild to moderate arthrosis with a large dorsal osteophyte but is less likely to yield favorable outcomes in joints with advanced arthritis [35].

Surgical Approach / Technique: Arthroscopic dorsal cheilectomy, plantar capsular release, flexor hallucis brevis release, and sesamoid cheilectomy constitute the standard joint-preserving approach for early stages [1]. During open cheilectomy, approximately one fourth to one third of the dorsal metatarsal head is excised with an osteotome, medial and lateral osteophytes are debrided, and a thorough synovectomy is performed [35]. For moderate hallux rigidus with a negative metatarsal index before stage III, a combination of cheilectomy and proximal phalanx osteotomy is utilized [17, 50]. Distal oblique osteotomy is an effective procedure for grade II disease, allowing immediate full weight bearing in a postoperative shoe for 6 weeks and initiation of active and passive dorsiflexion and plantarflexion exercises on the first postoperative day [79]. Arthroscopic microhole drill technique may be applied for focal chordal injury in patients who failed conservative therapy [29]. The arthrectomy described by Valenti serves as a reproducible compromise between mobility and stability across all grades [24]. Percutaneous forefoot surgery produces results similar to conventional surgery [3].

Implant Selection: Prosthetic replacement options include a double-stemmed silastic implant, which provides predictable outcomes comparable to arthrodesis for end-stage disease [19]. First MTP joint total arthroplasty offers durable pain relief, functional improvement, and motion preservation [20]. However, prosthetic replacement has high failure rates in younger, more active individuals and is best suited for older, lower-demand patients [35]. Interposition arthroplasty relieves pain and restores motion in advanced cases, offering a reliable alternative to fusion [13]. The Keller procedure, a resection arthroplasty, may be useful in older, less active patients but carries a high rate of complications [35].

Other Considerations: Joint-preserving operations increase dorsiflexion and decrease daily pain in grade I and II patients [12]. Post-cheilectomy, patients regain up to 50% of dorsiflexion with improved total motion, and more than 90% report improved pain, shoe-wearing ability, and physical capabilities [35]. Arthroscopic cheilectomy patients are allowed to weight-bear as tolerated in a hard-soled shoe with no limitations on flexion or extension [28]. A sound arthrodesis confers freedom from pain and high functional efficiency, allowing patients to remain quite active despite the drawback of lost joint motion [11, 35]. Cheilectomy uniformly failed in patients with Grade-4 hallux rigidus, with two of four remaining patients experiencing moderate to severe MTP pain [33]. In Grade-3 cases where cheilectomy failed, radiographic chondrolysis developed within one year, and both patients subsequently underwent arthrodesis at seven and eight years post-cheilectomy [33].

Complications

Hallux varus: Hallux varus is usually acquired in adults as a complication of hallux valgus surgery [23]. Causes of acquired hallux varus include overcorrection from bunion surgeries such as the McBride procedure, trauma, and systemic arthritis [23]. In a salvage series of 29 feet following failed Keller resection arthroplasty, one case of postoperative hallux varus was the result of a nonunion [74].

Failed Cheilectomy: Cheilectomy uniformly failed in patients with Grade-4 hallux rigidus, with five of nine feet subsequently requiring arthrodesis and two of the remaining four patients experiencing moderate to severe metatarsophalangeal joint pain [33]. Cheilectomy unexpectedly failed in two of thirty-four patients with Grade-3 hallux rigidus, both of whom developed radiographic evidence of chondrolysis within one year after surgery and subsequently underwent arthrodesis [33].

Other Considerations: Hallux arthroscopy shows minor findings in patients with degenerative arthrosis and osteophytes who may require other techniques [52]. For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired [21]. In hallux valgus feet with postoperative metatarsalgia, central rays show indicative differences in instant load distribution rather than peak or cumulative load [21].

Recovery

Postoperative Management: Meticulous postoperative management is required to ensure optimal alignment of the hallux [9]. Preoperative alterations in hallux and forefoot positions shift towards normal following cheilectomy [18].

Joint-Preserving Outcomes: In patients with grade I and II hallux rigidus, joint-preserving operations increase dorsi flexion [12] and decrease daily pain [12]. For advanced hallux rigidus, interposition arthroplasty relieves pain [13] and restores motion [13].

Arthrodesis Outcomes: Arthrodesis of the first metatarsophalangeal joint confers freedom from pain in a very high proportion of patients with hallux rigidus [11]. It also confers a high level of functional efficiency in a very high proportion of these patients [11].

Arthroplasty Outcomes: Double-stemmed silastic implant arthroplasty provides outcomes comparable to arthrodesis for the treatment of end-stage hallux rigidus [19]. First metatarsophalangeal joint total arthroplasty provides durable pain relief [20], functional improvement [20], and preserves joint motion in patients with hallux rigidus [20].

Key Evidence

  • [L5] The procedure is indicated for symptomatic grade 1 or 2 hallux rigidus recalcitrant to conservative treatment. [1] (10.1016/j.eats.2024.103198)
  • [L3] The reliability and validity of current grading criteria for hallux rigidus may require further exploration. [2] (10.5435/jaaos-d-16-00878)
  • [L5] The procedure is particularly reliable for fifth ray abnormalities and produces results similar to conventional surgery for hallux valgus and hallux rigidus. [3] (10.1016/j.otsr.2013.06.017)
  • [L4] These findings are consistent with theoretical models of foot function, and may explain the development of secondary changes associated with hallux limitus/rigidus. [4] (10.1002/jor.20700)
  • [L5] Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes. [5] (10.2106/00004623-199806000-00015)
  • [L4] Patients with hallux rigidus demonstrated prolonged stance phase and sagittal plane ROM limitations in the hallux compared to controls. [6] (10.1002/jor.20506)
  • [L5] The postoperative management must be meticulously carried out to ensure optimal alignment of the hallux. [9] (10.5435/00124635-199501000-00005)
  • [L4] This study suggests that a sound arthrodesis of the metatarsophalangeal joint confers freedom from pain and a high level of functional efficiency in a very high proportion of patients who suffer from hallux valgus and hallux rigidus. [11] (10.2106/00004623-196345030-00003)
  • [L3] The joint preserving operation in patients with grade I and II hallux rigidus shows an increase of dorsi flexion and decrease of daily pain. [12] (10.1007/s00402-009-0857-1)
  • [L4] Results of our study indicate that interposition arthroplasty relieves pain and restores motion in patients with advanced hallux rigidus and may offer a reliable option to fusing the joint. [13] (10.1097/01.blo.0000201166.82690.23)
  • [L5] [15] (10.2106/00004623-198668030-00012)
  • [L4] Surgery is selected based on the grade of involvement, with early to mid-stage hallux rigidus best managed with cheilectomy or cheilectomy and proximal phalanx osteotomy, while arthrodesis and arthroplasty are reserved for late-stage hallux rigidus. [17] (10.5435/jaaos-20-06-347)
  • [L3] Altered hallux and forefoot positions preoperatively showed shifts towards normal after cheilectomy. [18] (10.1002/jor.20711)
  • [L4] These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage hallux rigidus. [19] (10.1302/0301-620x.102b2.bjj-2019-0518.r2)
  • [L4] First MTP joint total arthroplasty provides durable pain relief, functional improvement, and preservation of joint motion in patients with hallux rigidus. [20] (10.1007/s00264-026-07008-6)
  • [L3] For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired, while central rays show indicative differences in instant load distribution rather than peak or cumulative load. [21] (10.1186/s13018-017-0622-z)
  • [L4] The arthrectomy described by Valenti is a highly reproducible intervention that serves as a good compromise between mobility and stability, providing good results for all hallux rigidus grades and entailing a low complication rate. [24] (10.1016/j.otsr.2009.02.004)
  • [L5] Patients are allowed to weight-bear as tolerated in a hard-soled shoe with no limitations on flexion and extension of the great toe MTPJ. [28] (10.1016/j.eats.2022.12.014)
  • [L3] Arthroscopic microhole drill technique can be applied with impressive functional scores and without any complication in persons who failed conservative therapy for hallux rigidus with focal chordal injury. [29] (10.1177/2325967117s00069)
  • [Paper] These findings suggest that foot alignment changes with loading, making it important to measure bone positions in controlled conditions. [40] (10.1002/jor.25283)
  • [L3] Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet. [47] (10.2106/jbjs.24.00437)
  • [L4] [50] (10.1016/j.otsr.2023.103710)
  • [Paper] Non-surgical intervention begins with shoe modifications and orthotics. [51] (10.1302/2058-5241.2.160031)
  • [L4] Hallux arthroscopy has good outcomes without complications for osteochondral lesions, loose bodies, and synovitis, but shows minor findings in patients with degenerative arthrosis and osteophytes who may require other techniques. [52] (10.1177/2325967114s00257)
  • [L4] [61] (10.1186/s12891-021-04666-y)
  • [L5] Weight-bearing CT scans better demonstrate the true orientation of bones and joints during loading compared to standard imaging, aiding in the diagnosis and preoperative planning of complex foot and ankle pathologies. [64] (10.5435/jaaos-d-19-00700)
  • [L3] [74] (10.2106/00004623-200406000-00003)

See Also

References

[1] Arthroscopic Dorsal Cheilectomy, Plantar Capsular Release, Flexor Hallucis Brevis Release, and Sesamoid Cheilectomy for Management of Early Stages of Hallux Rigidus. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103198

[2] Hallux Rigidus Grade Does Not Correlate With Foot and Ankle Ability Measure Score. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00878

[3] Percutaneous forefoot surgery. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2013.06.017

[4] Plantar pressure distribution in older people with osteoarthritis of the first metatarsophalangeal joint (hallux limitus/rigidus). Journal of Orthopaedic Research. 2008. DOI: 10.1002/jor.20700

[5] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[6] Quantitative characterization of gait kinematics in patients with hallux rigidus using the Milwaukee foot model. Journal of Orthopaedic Research. 2007. DOI: 10.1002/jor.20506

[9] Disorders of the First Metatarsophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 1995. DOI: 10.5435/00124635-199501000-00005

[11] Arthrodesis of the First Metatarsophalangeal Joint for Hallux Valgus and Ridigus. The Journal of Bone & Joint Surgery. 1963. DOI: 10.2106/00004623-196345030-00003

[12] Mid- and long-term results of the joint preserving therapy of hallux rigidus. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-0857-1

[13] Outcomes after Interposition Arthroplasty for Treatment of Hallux Rigidus. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000201166.82690.23

[15] Kinematics of the first metatarsophalangeal joint.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668030-00012

[17] Surgical Management of Hallux Rigidus. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-06-347

[18] Quantitative motion analysis in patients with hallux rigidus before and after cheilectomy. Journal of Orthopaedic Research. 2008. DOI: 10.1002/jor.20711

[19] Silastic first metatarsophalangeal joint arthroplasty for the treatment of end-stage hallux rigidus. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b2.bjj-2019-0518.r2

[20] Long-term clinical, functional and radiological outcomes after total arthroplasty of the first metatarsophalangeal joint in the treatment of hallux rigidus. International Orthopaedics. 2026. DOI: 10.1007/s00264-026-07008-6

[21] Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0622-z

[23] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Plate 15.3 Kramer/Barmada Osteotomy of the Base of the Femoral Neck for Slipped Capital Femoral Epiphysis > Distal Metatarsal Osteotomy > Hallux Varus.

[24] The Valenti technique in the treatment of hallux rigidus. Orthopaedics & Traumatology: Surgery & Research. 2009. DOI: 10.1016/j.otsr.2009.02.004

[28] Dorsal Cheilectomy Using Great Toe Metatarsophalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2022.12.014

[29] Arthroscopic Treatment of Focal Osteochondral Lesions of the First Metatarsophalangeal Joint. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00069

[33] Hallux rigidus Grading and long-term results of operative treatment. 2004.

[35] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 8Foot and Ankle Surgery > 2. Hallux Rigidus.

[40] Foot radiographic angle variation as a function of weightbearing magnitude. Journal of Orthopaedic Research. 2022. DOI: 10.1002/jor.25283

[44] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Plate 15.3 Kramer/Barmada Osteotomy of the Base of the Femoral Neck for Slipped Capital Femoral Epiphysis > Hallux Rigidus.

[47] Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00437

[50] Percutaneous arthroscopically assisted cheilectomy combined to percutaneous proximal phalanx osteotomy in hallux rigidus: Clinical and radiological outcomes in 30 feet at a 48-month follow-up. Orthopaedics & Traumatology: Surgery & Research. 2024. DOI: 10.1016/j.otsr.2023.103710

[51] Hallux rigidus. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160031

[52] Efficacy, Indications and Limitations of Hallux Arthroscopy. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00257

[61] Prevalence of and risk factors for hallux rigidus: a cross-sectional study in Japan. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04666-y

[64] Weight-bearing CT Scans in Foot and Ankle Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00700

[74] Salvage of a Failed Keller Resection Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200406000-00003

[79] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > DISTAL OBLIQUE OSTEOTOMY FOR HALLUX RIGIDUS.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.