A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus.

Forty-four patients (47 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Each foot was initially graded according to a four-stage hybrid hallux rigidus radiographic grading system. A subjective evaluation based on a modified American Orthopaedic Foot and Ankle Surgery clinical rating system was performed. An objective physical examination was performed. Angular and linear measurements were obtained from standard weightbearing radiographs. The extent of articular derangement for the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids were graded according to the American Orthopaedic Foot and Ankle Society intraoperative grading system. Finally, a means of quantifying the percentage of first metatarsal head articular derangement was performed. Significant differences were identified between joints radiographically classified as grade II, which had lower nonweightbearing, relaxed hanging position (p = .041); nonweightbearing assisted dorsiflexion (p = .000); actual nonweightbearing dorsal range of motion (p = .002); and actual plantar range of motion (p = .009) than those classified as grade I. The angle of deviation of the second metatarsophalangeal joint revealed a significant increase in degree of medial angulation as the grade increased (p = .000). None of the remaining radiographic measurements were significant. A correlation between the hybrid radiographic grading system and percentage of actual intraoperative articular derangement was shown to exist.