The aim of this study was to compare the effects of hallux valgus and hallux rigidus on foot health status (health-related quality of life) in participants seeking surgical opinion. Such a benchmarking activity has not previously been reported. Comparing the impact of hallux valgus and hallux rigidus on foot health status is important, as accurate diagnosis and classification is not straight forward. The pain and deformity of hallux rigidus can clinically mimic hallux valgus, and the deformity of hallux valgus can result in arthrosis, similar to hallux rigidus. The difficulty in diagnosis and classification can be illustrated using the following examples from the literature. Coughlin and colleagues acknowledged that some patients having undergone surgery for hallux valgus were later excluded from their study of hallux valgus due to the presence of arthritis . While in another study, 12% of included patients in a study of hallux rigidus  presented with radiological findings indicative of hallux valgus.
Impact of hallux valgus and hallux rigidus on health-related quality of life
Previous studies have shown that hallux valgus has a significant and detrimental effect on various parameters of generic health-related quality of life [2, 12], however no studies have been identified that compare hallux valgus and hallux rigidus, particularly in relation to their effect on foot-specific health-related quality of life (e.g. using the Foot Health Status Questionnaire).
The Foot Health Status Questionnaire was designed as a measurement instrument for outcomes studies, where an intervention is given and the outcome of interest is measured before and after administration of the intervention. However, it can also be used to compare health-related quality of life across conditions affecting the feet (e.g. hallux valgus to hallux rigidus). Ideal values in each domain are represented by the score 100 (0 – 100 scale). The authors are unaware of any normative data for individuals who have no pathology in the great toe joint. In this study, the Foot Health Status Questionnaire scores for hallux valgus were well below the ideal of 100 (60.6 for pain, 74.7 for function, 25.1 for shoe fit and 35.5 for general foot health). Similarly, for hallux rigidus the mean scores were also well below the ideal (46.9 for pain, 59.7 for function, 24.8 for shoes and 36.7 for general foot health).
While hallux valgus and hallux rigidus both cause significant reduction in health-related quality of life, our results clearly demonstrate that hallux rigidus is a more debilitating condition than hallux valgus in a cohort seeking surgical advice from a podiatric surgeon. Importantly, there was no significant difference in age – which would be associated with the Foot Health Status Questionnaire results – between the hallux valgus and hallux rigidus groups. This rules out this potential confounder (i.e. that one group might have had worse health-related quality of life simply because they were on average older) and strengthens our findings. The findings from this study, therefore, provide evidence that hallux rigidus has a greater negative impact compared to hallux valgus in the key areas of pain and function. The lack of significant difference between the two conditions in respect of footwear and general foot health reflects that although there are distinct differences in pain and function, there are also some similarities. Alternatively, it is possible that the shoe fit and general foot health domains of the Foot Health Status Questionnaire are not sufficiently sensitive to detect clinically worthwhile differences between the two conditions. The authors are not aware of any previous studies which have reported the relative impacts of these conditions on these domains. These findings are of interest and further research would be of use to explore both the apparent similarities in impact on foot health of these conditions and the sensitivity of the footwear and general foot health domains of the Foot Health Status Questionnaire for detecting differences between hallux valgus and hallux rigidus.
These findings lend support to a growing body of research suggesting that great toe joint pathology is a significant health issue [6, 7, 12]. Our findings add to this body of research by demonstrating that some forms of great toe joint pathology have greater impact than others.
Prevalence and gender distribution of hallux valgus and rigidus
It is commonly reported that hallux valgus has a high prevalence within the community and particularly amongst women . Little has been reported on the prevalence of hallux rigidus. In this study hallux valgus was the more common presenting pathology (68% hallux valgus versus 32% hallux rigidus). With respect to gender distribution, women were disproportionately represented (82%) in the overall cohort. These findings are generally consistent with the literature [5–9, 11, 21].
Of further interest is the proportion of participants with hallux valgus and hallux rigidus within males and females, indicating a possible gender bias of each condition in patients presenting to podiatric surgeons. In the male cohort, 33% presented with hallux valgus, whereas 76% of the female cohort presented with the same condition. In contrast, 67% of the males presented with hallux rigidus, whereas only 24% of the females presented with this pathology. Although one study  reports females as more commonly presenting with hallux rigidus, the proportion of males presenting with hallux rigidus in our study is supported by earlier reports of 60% to 64% [21–23]. Variations in gender predisposition reported in the surgical literature may not necessarily indicate that females develop these conditions more commonly, it may simply show that females are more likely to present for surgical advice than men.
Limitations of the study
There are a number of limitations that need to be considered with respect to this study. Firstly, there was no control group of participants with absent great toe joint pathology. A case-control study would provide a more accurate representation of impact of the conditions relative to normative population values. Secondly, diagnosis of participants in this study was dependent on a clinical diagnosis, including x-rays, made by the participating surgeons. As there were seven surgeons involved in collecting data, some individual variation may have occurred in the accuracy of the data collected that related to the diagnosis and the coding of the diagnosis. To reduce this potential for error, only experienced foot surgeons were recruited and training was provided to each surgeon on the classification systems used in the study. Thirdly, the findings from this study reflect the status of patients in Australia presenting to foot surgeons and caution is needed generalising these findings to the wider population. Finally, some criticisms have been raised about the Foot Health Status Questionnaire, including its initial development, validation and its ability to discriminate levels of general foot health [24, 25]. However, in a comparison with other foot and ankle outcomes by Suk and colleagues  the Foot Health Status Questionnaire was rated the highest in quality (methodological quality and clinical utility) of 25 foot and ankle outcome measures.