Efficacy of First MTPJ Arthrodesis as a Treatment in Hallux Rigidus

Inclusion Criteria: * Age 40 years or over * Diagnosis of hallux rigidus: Persistent pain on movement of the first MTPJ AND Osteoarthritic first MTPJ in plain X-rays * Duration of symptoms ≥1 year * Pain-NRS during walking of 4 or more on a scale 0-10 (higher is worse) * No substantial pain in other joints of the foot in clinical examination * Willingness to accept both treatment options * Ability to understand trial information and answer outcome assessments in Finnish * Signed informed consent Exclusion Criteria: * ASA\* physical status classification level III or higher * Patients with weak co-operation (dementia, schizophrenia, etc.) * Patients with neuropathy, i.e. unable to feel 10g monofilament pressure in less than 8 out of 10 standard testing sites * Active bacterial infection or ulcer of the lower limb * Diabetes mellitus with insulin treatment * Diabetes mellitus and GHb-A1C \>64 mmol/mol (regardless of treatment) * History of rheumatoid arthritis, gout or other inflammatory arthritis of the foot * Hallux valgus angle \>15° in weight-bearing X-ray * Hallux varus in weight-bearing X-ray * Large bone cysts in X-ray probably requiring bone grafting in surgery * Pain in passive manipulation of ipsilateral first toe IP joint * Patients with severe circulatory disorder of the lower limb: absence of palpable pulses in the foot (both dorsalis pedis artery and tibialis posterior artery) * History of surgery of the foot in question * Neuropathic pain of the foot in question (i.e., use of neuropathic analgesics) * Activity limiting symptoms from an earlier fracture or ligament injury of the foot * Patient is not willing to accept the operation within the planned time limits (3 to 12 weeks post-randomisation)