Current Concepts Review

Abstract

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 and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intraarticular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.

Hallux rigidus: Conceptos actuales

“…La metatarsalgia por transferencia y dolor neurítico se debe al pinzamiento de la rama medial del nervio peroneo superficial por los osteofitos dorsales. 3 13 14 Estos, a su vez, generan una prominencia dorsal sobre la articulación metatarsofalángica denominada juanete dorsomedial 3 13 14 ( Fig. 2 ).…”

Cheilectomy With or Without Cryopreserved Amniotic Membrane–Umbilical Cord Allograft for Hallux Rigidus

“…21 Arthritis of the hallux MTPJ is a progressive condition, and concerns exist about postoperative stiffness, recurrent pain, and need for revision surgery following cheilectomy. 3 There has been increased interest in adjuvants, modifications, and alternatives to cheilectomy to attempt to improve on results. Various soft tissue interpositions as well as a polyvinyl alcohol hydrogel implant have been described.…”

“…It affects 10% of adults and is present on radiographs in 20% to 48% of adults older than 40 years. 3 Hallux rigidus has a clinical and radiographic scoring system that is both descriptive and helpful in guiding treatment. It incorporates degree of radiographic change (joint space narrowing and osteophyte formation) and accounts for pain and range of motion.…”

“…Various soft tissue interpositions as well as a polyvinyl alcohol hydrogel implant have been described. 3,4,14,21 An alternative to mechanical adjuvants is biologic supplementation to attempt to mitigate postoperative inflammation and scar formation.…”

A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint 

“…Joints in the foot are often affected by this condition with the 1 st MPJ being most commonly affected pedal joint [6]. Symptomatic 1 st MPJ OA affects approximately 10% of the adult population and the prevalence increases with age -as do comorbidities amongst sufferers -with the result that reduced pharmacological treatment options available for pain relief in these patients [7]. Symptoms arising from OA are notoriously di cult to manage with oral analgesics alone: this ultimately results in a signi cant burden on primary care services [8].…”