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

Abstract

Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.

Keywords: First metatarsophalangeal joint; Hallux rigidus; Joint preserving; Operative treatment; Osteoarthritis; Osteotomy.

Figure 1

Radiographic images of a hallux rigidus grade 2. A: Dorso-plantar view; B: Oblique view; C: Stress radiographs in dorsiflexion revealing bony impingement.

Figure 2

Diagrammatic presentations. A: A Cheilectomy; B: A proximal phalanx osteotomy (Moberg); C: A dorsal closing wedge osteotomy (Watermann); D: A Watermann Green procedure; E: A Youngswick procedure; F: A Reverdin Green osteotomy; G: A distal oblique sliding osteotomy; H: The Sagittal Z osteotomy; I: A Drago procedure.