Table 2.

Coughlin and Shurnas Classification of Hallux Rigidus.

Grade	Dorsiflexion	Radiographic Findings a	Clinical Findings
0	40°-60° (20% loss of normal motion)	Normal	No pain. Only stiffness and loss of motion
1	30°-40° (20%-60% loss of normal motion)	Dorsal osteophyte. Minimal joint space narrowing, periarticular sclerosis and flattening of the metatarsal head	Mild or occasional pain and stiffness at the extremes of movements
2	10°-30° (50%-75% loss of normal motion)	Dorsal, lateral, possibly medial osteophytes with flattened appearance to the metatarsal head; less than one-fourth of the dorsal joint space is involved on the lateral radiograph; mild to moderate joint space narrowing and sclerosis; sesamoids not involved	Moderate to severe pain and stiffness. Pain occurs just before maximum dorsiflexion and maximum plantarflexion
3	≤10° (75%-100% loss of normal motion). Loss of plantarflexion as well (often ≤10°)	Same as in grade 2 but with substantial narrowing, cystic changes, more than one-fourth of the dorsal joint space is involved on the lateral radiograph, sesamoids enlarged, cystic, and/or irregular	Constant pain and substantial stiffness at the extremes of range of motion but not at midrange
4	Same as in grade 3	Same as in grade 3	Same as in grade 3 but with hindrance of passive motion

^aWeight-bearing anteroposterior and lateral.

Source: Adapted from Coughlin MJ, Shurnas PS. Hallux rigidus: grading and long-term results of operative treatment. J Bone Joint Surg Am 2003;85(11):2073.