Hallux Rigidus

Abstract

Degenerative arthritis of the first metatarsophalangeal joint was initially described by Davies-Colley" in 1887. One year later Cotterill coined the term hallux rigidus. The gradual onset of pain and limitation of dorsiflexion at the metatarsophalangeal joint Mzlz* l 7 s Z 9 is characteristic of the disease process, although often there may be a normal range of plantar flexion.21 ETIOLOGYThe degenerative process has been attributed to numerous causes. Poor foot-~e a r ,~~~~ a long narrow ~o o~,~,~~J~ pronated feet,z*7,1z,17,1M, 19rz9 osteochondritis dissecans , 1 3 , 2 0 * 2 1 a long first metatarsal , 2 , z 9 * 3 1 hyperextension of the first metatarsal , 3 * 1 7 3 z 1 an imperfect ball-and-socket relationship of the first metatarsophalangeal artic~lation,~ abnormal gait,z obesity,12 trauma,#. 12, z6,35 sex ,3, 26, z9, 30 and occupation have all been associated with hallux rigidus. McMasteP believes that either acute or chronic trauma could produce an osteochondral fracture leading to the eventual *

Manipulation and injection for hallux rigidus

“…Those which preserve the joint include open and arthroscopic dorsal cheilectomy, for which excellent results have been reported. 3,6,8,13,16 In 1927 Cochrane, Marked joint-space narrowing, advanced subchondral sclerosis and/or large circumferential spurs (especially dorsally) and degenerative changes at the hallux-sesamoid articulations Fig. 1 Kaplan-Meier survival estimates of time to surgical treatment being recommended.…”

“…1 Many aetiologies have been proposed including trauma, but most cases are idiopathic. 2,3 The patient presents with gradual onset of pain, swelling and stiffness of the first metatarsophalangeal joint (MTPJ). There is limited dorsiflexion due to the formation of osteophytes around the dorsal aspect of the articular margin on the head of the first metatarsal.…”

Clinical and Radiological Outcomes of Hallux Rigidus Treated With Cheilectomy and a Moberg-Akin Osteotomy

“…10,19 The osteotomy union rate in our study was 100%, comparable to results from other studies, while the nonunion rate after arthrodesis is reported to be approximately 15%. 20 Unlike arthrodesis, joint-preserving procedures avoid loss of mobility and stability of the joint, 2,8,11,16,22 with minimal postoperative morbidity and a shorter rehabilitation. 8,11,16,22…”

“…For advanced stage hallux rigidus, arthrodesis is considered the gold standard, 7,8,20 with predictable and consistent satisfactory results in 90% of cases, 6,10,16,19 although at the cost of mobility at the first MTPJ 16 and possible complications of nonunion, malrotation, and arthritis of the interphalangeal joint. 10,19 The osteotomy union rate in our study was 100%, comparable to results from other studies, while the nonunion rate after arthrodesis is reported to be approximately 15%.…”

“…8,10,19,24 In general, for early stages of hallux rigidus, joint-preserving procedures are recommended, while for advanced stages of hallux rigidus, arthrodesis is considered the gold standard. 7-8,10,16,19 Since many patients with hallux rigidus also exhibit a mild hallux valgus and/or hallux valgus interphalangeus, 26 Hunt and Anderson 12,13 proposed a dorsal cheilectomy with combined Moberg and Akin osteotomies to decompress both the dorsal and lateral aspect of the first MTPJ. The aim of this study was to evaluate the clinical and radiological outcome after cheilectomy and biplanar osteotomy of the proximal phalanx for patients with mild and advanced stages of hallux rigidus.…”