A 48-year-old man presents with pain over the top of the first metatarsophalangeal joint, aggravated by walking uphill and wearing shoes. There is a visible dorsal bump, the joint is stiff with restricted and painful dorsiflexion, and there is no significant lateral deviation of the great toe. Radiograph shows dorsal osteophytes with joint space narrowing. The most likely diagnosis is:
- A Hallux valgus
- B Hallux rigidus ✓
- C Sesamoiditis
- D Gouty arthritis
Correct answer: B. Hallux rigidus
Explanation
Hallux rigidus is degenerative arthritis of the first metatarsophalangeal joint presenting with dorsal pain, a dorsal osteophyte (dorsal bunion), stiffness, and loss of dorsiflexion, without the lateral deviation that defines hallux valgus. Early disease is treated with cheilectomy of the dorsal osteophyte. Sesamoiditis causes plantar pain under the first metatarsal head, gout presents with acute inflammatory episodes, and hallux valgus shows lateral angulation with an increased intermetatarsal angle rather than isolated dorsal impingement.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.