Hallux limitus is the term used to define a progressive pathology of the first MTPJ with limited dorsiflexion in the sagittal plane. Traditionally the restricted motion in this joint is considered dorsiflexion of less than 65°. Hallux rigidus is a progression of the deformity in which motion in the joint is limited to less than 10° of dorsiflexion.² The progression of this condition has prompted various debates as well as classifications in the literature, based predominantly on the combination of clinical and radiographic findings (Table 1). Causes of this deformity include increased age, female gender, trauma, previous surgery, osteochondritis desiccans, and rheumatoid and other arthropathies.

Table 1 Summary of Regnauld classification⁴

Several biomechanical factors have been attributed to the progression of this deformity. Root and colleagues described 5 biomechanical causes of hallux limitus including elongated first metatarsal, hypermobility of the first ray, immobilization, degenerative joint disease, and metatarsus primus elevatus.³ Other biomechanical etiologies including pes planus, metatarsus adductus, long proximal phalanx of the hallux, sesamoid abnormality, tarsal coalition, and hallux valgus (Box 1).

First MTPJ arthrodesis has been a mainstay in the treatment of a wide variety first MTPJ disorders. The procedure frequently has been the choice for a definitive solution for degenerative changes of the first MTPJ. Removing damaged articular surfaces and eliminating motion is a cornerstone of the treatment of chronic osteoarthritis pain in the foot. Chronic joint pain from hallux limitus/rigidus, especially degenerative joint disease categorized in the latter stages, has been treated with surgical fusion. However, it has been debated in the literature whether a total-implant arthroplasty or arthrodesis has a more favorable long-term outcome. Gibson and colleagues evaluated patients 2 years after arthroplasty and arthrodesis surgery, concluding that arthrodesis has fewer postsurgical complications and a higher satisfaction rate among patients.⁶ First MTPJ arthrodesis is by no means restricted to symptoms from osteoarthritis. Jenter and colleagues used fusion to treat cerebral palsy–induced hallux valgus with favorable outcomes.⁷ Gout, rheumatoid arthritis, and Charcot are also pathologies in which arthrodesis has generated promising results. Finally, arthrodesis has been used for first-ray salvage procedure including failed hallux valgus or MTPJ implant surgery, osteomyelitis, or trauma.⁸