skip to main content

Hallux rigidus — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateAnkle and FootHallux rigidusMSRA

A 56-year-old woman presents with 8 months of gradually progressive pain at the dorsum of her right first metatarsophalangeal joint. Pain is worst during push-off when walking uphill and when wearing heeled shoes. She has no history of acute injury, psoriasis, inflammatory arthritis or previous gout. Simple analgesia has provided limited benefit. Examination shows a firm dorsal bony prominence over the first metatarsophalangeal joint. Dorsiflexion is markedly restricted and reproduces her pain, with palpable crepitus. There is no joint warmth, erythema, effusion or skin breakdown. Pedal pulses and sensation are normal. What is the most appropriate management today?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Initiate conservative management with analgesia, education, footwear and activity modification, and community podiatry input

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

This is hallux rigidus: degenerative first metatarsophalangeal joint disease causing progressive pain and stiffness, dorsal osteophyte formation, and painful restricted dorsiflexion during push-off. The absence of acute onset, warmth, erythema or effusion makes an acute crystal arthritis unlikely. Initial UK primary-care management is conservative, including education, analgesia, activity modification and podiatry input. Footwear measures that reduce painful first-MTP movement, such as a stiff or rocker sole and an adequately wide toe box, are appropriate. Referral for operative opinion is considered after primary-care measures have failed, not as the first step in this presentation. B is initially attractive because weight-bearing radiographs can support assessment when referral for surgery is being considered; however, she has not yet had an adequate conservative-management trial. C is inappropriate because there are no urgent features and surgery is reserved for persistent disabling symptoms despite non-operative care. D is not routinely needed where the clinical diagnosis is clear. E would be appropriate for an acute inflammatory monoarthritis suggestive of gout, which this presentation is not.

Reference: Hallux rigidus — NHS Borders Ref Help Toolkit (Last reviewed 31 July 2025) — https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/orthopaedic/foot-and-ankle/hallux-rigidus/ Hallux rigidus — NHS Borders Podiatry Ref Help Toolkit (Date not stated) — https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/podiatry/hallux-rigidus/