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The second most common deformity of the forefoot after hallux valgus, hallux rigidus is osteoarthritis of the big toe joint. Often very painful, it comes with stiffness and osteophytes. In the early stages, FHL tenolysis has a genuine role to play.
After the hallux valgus deformity, hallux rigidus is the most common condition of the forefoot. Hallux rigidus refers to a joint deformity due to osteoarthritis, that is, to the loss of the cartilage on either side of the metatarsophalangeal joint of the first ray.
It is an often very painful condition, most commonly accompanied by joint stiffness and by bone spurs called osteophytes, which create painful pressure points in shoes.

In the early stages of osteoarthritis, decompressive surgery such as tenolysis of the flexor hallucis longus (FHL) can have its place. The “bowstring” effect of the FHL tendon, present in Functional Hallux Limitus, does indeed lead to increased joint stress and is a predisposing factor for osteoarthritis and for the worsening of the symptoms.
Conservative treatment, on the other hand, is only rarely indicated, because of the pain that the tendon-stretching maneuvers can cause. Other surgical solutions are offered in cases of advanced osteoarthritic lesions.
A round table held by the AFCP, with Dr Vallotton, reviews hallux rigidus and its management.
In the early stages, identifying and treating FHL can slow the progression of osteoarthritis. The mobility assessment at the Centre du pied can objectively identify the FHL and guide management.
Nature
osteoarthritis of MTP 1
Frequency
2nd most common forefoot deformity
Signs
stiffness, osteophytes
Early stage
FHL tenolysis
Mechanism
FHL bowstring effect
Underlying cause
Functional Hallux Limitus