Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature

Table 1 Clinical and radiographic grading for hallux rigidus

Grade	Dorsiflexion	Radiographic findings	Clinical findings
0	40°-60° and/or 10%-20% loss compared with normal side	Normal	No pain; only stiffness and loss of motion
1	30°-40° and/or 20%-50% loss compared with normal side	Dorsal osteophyte (main finding), minimal joint space narrowing, periarticular sclerosis, flattening of metatarsal head	Mild or occasional pain and stiffness, pain at extremes of dorsiflexion and/or plantar flexion
2	10°-30° and/or 50%-75% loss compared with normal side	Dorsal, lateral, and possibly medial osteophytes (flattened metatarsal head) < 1/4 of dorsal joint space involved (lateral radiograph), mild to moderate joint-space narrowing and sclerosis, sesamoids not involved	Moderate to severe pain and stiffness that may be constant; pain just before maximum dorsiflexion and maximum plantar flexion
3	≤ 10° and/or 75%-100% loss compared with normal side. Notable loss of plantar flexion (often ≤ 10°)	Same as in Grade 2 but with substantial narrowing, possibly periarticular cysts, > 1/4 of dorsal joint space involved (lateral radiograph), sesamoids enlarged and/or cystic and/or irregular	Nearly constant pain and substantial stiffness at extremes of range of motion but not at mid-range
4	Same as in Grade 3	Same as in Grade 3	Same as in Grade 3 but definite pain at mid-range of passive motion