Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient's goal and expectations, and surgeon's experience with the technique.

Hallux rigidus: How do I approach it?

Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options range from joint-preserving procedures (eg, cheilectomy with or without associated osteotomies) to joint-altering procedures (eg, arthroplasty or arthrodesis).

Clinical Presentation and Management of Hallux Rigidus

Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage an...

https://journals.sagepub.com/doi/pdf/10.1177/2473011418764461

Current Concepts Review: Hallux Rigidus

Background:Several operative interventions are available to alleviate pain in hallux rigidus, and the optimal operative technique is still a topic of debate among surgeons. Three of these are arthr...

Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome:

Background
Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.

https://link.springer.com/content/pdf/10.1186%2F1471-2474-13-148.pdf

Hypermobility of the first metatarsal bone in patients with rheumatoid arthritis treated by Lapidus procedure.

Background: We assessed the long-term results following Keller resection arthroplasty for the treatment of hallux rigidus. We then compared them with alternative surgical methods like cheilectomy, arthrodesis and joint replacement. Methods: Eighty-seven cases of Keller resection arthroplasty for hallux rigidus were reviewed with mean followup of 23 years. Their mean age at time of surgery was 50 years. Analysis included personal clinical evaluation with the AOFAS Hallux Score, quality-of-life assessment using the SF-36, radiographic assessment, pedobarographic evaluation and analysis of the patients' charts to detect any postoperative complications. Results: At the time of followup only five (5%) feet had undergone revision surgery. For all other cases we calculated a mean AOFAS score of 83 points. Sixty-nine of 73 unrevised patients (94%) would opt for this operation again under the same circumstances. SF-36 parameters showed age related normal values. Pedobarographic assessment revealed only moderate we...

Long-Term Results Following Keller Resection Arthroplasty for Hallux Rigidus

Background:The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no pr...

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes:

Long-term results of the Keller–Brandes procedure: Is the term “functional amputation” justified?

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Long-Term Results Following Keller Resection Arthroplasty for Hallux Rigidus

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes:

Long-term results of the Keller–Brandes procedure: Is the term “functional amputation” justified?