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Review
. 2017 Mar 13;2(1):13-20.
doi: 10.1302/2058-5241.2.160031. eCollection 2017 Jan.

Hallux rigidus

Bryant Ho  1 , Judith Baumhauer  2
Affiliations
Review

Hallux rigidus

Bryant Ho et al. EFORT Open Rev. .

Abstract

An estimated 40% of the US population have foot problems.Of all patients aged over 50 years, 2.5% report degenerative arthritis of the first metatarsophalangeal (MTP) joint, termed 'hallux rigidus'. First MTP osteoarthritis is the most common arthritic condition in the foot.Progression of great toe arthritis is associated with pain and loss of motion. Non-surgical intervention begins with shoe modifications and orthotics designed to limit MTP motion.In patients with mild arthritis, operative procedures focus on removing excess osteophytes (cheilectomy) to prevent dorsal impingement with or without a concomitant osteotomy (Moberg) to improve or shift range of motion into a less painful arc.In patients with more advanced arthritis, operative management has centred on arthrodesis of the first MTP joint.A recent Level 1 study shows excellent function and pain relief with a small hydrogel hemi-implant into the metatarsal headMultiple joint-sparing procedures such as joint arthroplasty or resurfacing have been described with inconsistent results. Cite this article: EFORT Open Rev 2017;2:13-20. DOI: 10.1302/2058-5241.2.160031.

Keywords: arthrodesis; great toe arthritis; hemi-arthroplasty; hydrogel, hallux rigidus.

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Conflict of interest statement

ICMJE Conflict of interest statement: JB has received financial support outside of this work in the form of Consultancy fees from Best Doctors, Cartiva Medical, DJO, Ferring Pharma, Nextremity Solutions, Wright Medical and Novostep.

Figures

Fig. 1
Fig. 1
Morton’s extension.
Fig. 2
Fig. 2
Cheilectomy. a) Dorsal osteophyte with dorsal and lateral arthritic changes to the metatarsal head, b) resection of dorsal osteophyte and 30% of the metatarsal head.
Fig. 3
Fig. 3
Failed hemiarthroplasty. a and b) anteroposterior and lateral radiographs demonstrating subsidence with angular and plantar migration of the implant.
Fig. 4
Fig. 4
Synthetic cartilage replacement. a) Intra-operative example of a synthetic cartilage replacement with preservation of collateral ligaments (photograph courtesy of Dr Christopher Blundell), b and c) anterior, posterior and lateral radiograhs after synthetic cartilage replacement.
Fig. 5
Fig. 5
Metatarsophalangeal (MTP) arthrodesis. a) Clinical evaluation of MTP positioning with toe-to-floor distance with simulated weight-bearing on a flat plate. b and c) Radiographs demonstrating MTP fusion with a lag screw and dorsal plate.
See this image and copyright information in PMC

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