Conditions of the Foot Quiz

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Hallux rigidus most accurately describes osteoarthritis affecting which joint?

A The first cuneonavicular joint
B The first metatarsosesamoid joint
C The interphalangeal joint of the hallux
D The first metatarsophalangeal joint of the hallux ✓
E The first tarsometatarsal joint

The answer is D: The first metatarsophalangeal joint of the hallux

Explanation

Why D is correct

See Hallux Rigidus. Option D is correct because hallux rigidus is osteoarthritis of the first metatarsophalangeal joint, the joint at the base of the big toe. Hallux means the big toe, and rigidus means stiff. The first metatarsophalangeal (MTP) joint is where the first metatarsal (the long bone behind the big toe) meets the proximal phalanx (the first bone of the toe). This joint takes high forces in walking, because the big toe bends upwards with every push-off, so it is a common site of wear-and-tear arthritis. Osteoarthritis is the loss of joint cartilage with formation of extra bone (bony spurs), and in the first MTP joint this leads to pain and stiffness, particularly when the toe is bent upwards. A registry of patients treated with surgery describes the condition as osteoarthritis of the first MTP-joint, and the average patient was 58 years old, with women making up a majority. The key point is the site, so the name tells you the joint. A memory aid: hallux rigidus is a stiff big toe, at the joint where the toe meets the foot.

Condition: hallux rigidus is osteoarthritis of the first metatarsophalangeal joint.
Site: the joint at the base of the big toe, where the first metatarsal meets the proximal phalanx.
Features: pain and stiffness, particularly when the toe is bent upwards.

Why the other options are incorrect

A. The first cuneonavicular joint: The first cuneonavicular joint lies between the navicular and the medial cuneiform, which is in the midfoot rather than at the base of the great toe. Osteoarthritis at this joint would not be described as hallux rigidus.
B. The first metatarsosesamoid joint: The first metatarsosesamoid joint is the small articulation between the first metatarsal head and the sesamoid bones on the plantar surface of the great toe. It is not the first metatarsophalangeal joint, and hallux rigidus does not name osteoarthritis of this articulation.
C. The interphalangeal joint of the hallux: The interphalangeal joint is the single joint within the big toe, nearer its tip. It can develop osteoarthritis, but that is not hallux rigidus, which affects the joint at the base of the toe. It would be named by the joint involved.
E. The first tarsometatarsal joint: The first tarsometatarsal joint is the articulation between the medial cuneiform and the base of the first metatarsal, so it lies in the midfoot rather than at the base of the big toe. Arthritis here would cause midfoot pain and stiffness, not the diagnosis of hallux rigidus.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
Which anatomical change best defines pes planus?
2
A 22-year-old woman has pain over the tip of her second toe. The distal interphalangeal joint of the toe is persistently flexed, and a tender corn has formed at the tip. The toe can still be straightened passively. Which management option is most appropriate at this stage?

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