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Hallux rigidus: How do I approach it?

Aaron Lam1, Jimmy J Chan1, Michele F Surace1

  • 1Aaron Lam, Albert Einstein College of Medicine, Bronx, NY 10461, United States.

World Journal of Orthopedics
|June 2, 2017
PubMed
Summary
This summary is machine-generated.

Hallux rigidus, a degenerative first metatarsalphalangeal joint disease, causes pain and limits motion. Treatment ranges from conservative care to surgical options like cheilectomy or arthrodesis, depending on disease severity.

Keywords:
ArthodesisArthrodiastasisArthroplastyCheilectomyHallux rigidusInterpositional arthroplastyMoberg osteotomy

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Area of Science:

  • Orthopedics
  • Rheumatology
  • Podiatry

Background:

  • Hallux rigidus is a degenerative condition affecting the first metatarsalphalangeal (MTP) joint, impacting 2.5% of individuals over 50.
  • Characterized by dorsal osteophytes and joint space narrowing, it leads to significant pain and restricted motion, altering gait mechanics due to high force transmission through the MTP joint.
  • While etiology is debated, trauma, hallux valgus interphalangeus, female gender, and inflammatory/metabolic conditions are associated factors.

Purpose of the Study:

  • To review the clinical presentation, diagnostic methods, and management strategies for hallux rigidus.
  • To compare joint-sparing and joint-sacrificing surgical interventions for hallux rigidus.
  • To discuss the role of newer procedures and the importance of personalized treatment selection.

Main Methods:

  • Literature review of hallux rigidus etiology, diagnosis, and treatment options.
  • Analysis of non-operative management strategies, including NSAIDs, injections, and physical therapy.
  • Categorization and discussion of surgical interventions, including cheilectomy, Moberg osteotomy, arthrodesis, implant/interpositional arthroplasty, and arthroscopy.

Main Results:

  • Non-operative treatments are the first line of management for hallux rigidus.
  • Joint-sparing procedures (cheilectomy, Moberg osteotomy) are effective for early stages.
  • Joint-sacrificing procedures like arthrodesis are the gold standard for advanced stages, with newer techniques showing promise but requiring further validation.

Conclusions:

  • Treatment for hallux rigidus should be individualized based on joint condition, patient goals, and surgeon expertise.
  • Conservative management should be exhausted before considering surgical intervention.
  • While established surgical options exist, ongoing research into newer procedures is crucial for optimizing long-term outcomes.