Optimization of Hallux Hyperdorsiflexion and Stiffness through an Individualized Surgical Intervention: A Case Report

Hallux hyperdorsiflexion and stiffness are typically associated with hallux rigidus. Although the underlying cause remains unclear, this case appears to have arisen in a patient undergoing treatment for schizophrenia, highlighting the importance of individualized and carefully tailored treatment approaches to achieve optimal patient outcomes and maintain high-quality care.

A 71-year-old Asian woman undergoing treatment for schizophrenia presented with severe hyperdorsiflexion and stiffness of the right hallux, causing intense pain, which was particularly noticeable during gait and daily activities. Initially, the patient underwent rehabilitation to restore normal active motion of the right extensor hallucis longus (EHL). However, despite continuous rehabilitation, the stiffness persisted. Consequently, the patient underwent surgery involving dissection, lengthening of the distal EHL, and partial transposition of the proximal EHL. Postoperatively, the patient regained active hallux movement and showed significantly improved gait.

Surgical treatment should be considered as an alternative option if symptoms persist for long in patients with hallux hyperdorsiflexion and stiffness. However, this approach is technically demanding and requires careful consideration of the strategy for successful recovery and optimal patient outcomes.