Hallux rigidus: How do I approach it?

Abstract

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 1^st 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.

Keywords: Hallux rigidus; Cheilectomy; Arthrodiastasis; Moberg osteotomy; Arthodesis; Interpositional arthroplasty; Arthroplasty

Core tip: Hallux rigidus is the leading form of arthritis of the foot. Patients experience increasing pain and decreasing motion of the first metatarsalphalangeal joint as the disease progress, leading to significant morbidity and lower quality of life. Multiple treatment options, from cheilectomy to arthrodesis, have been utilized in treating hallux rigidus. Advances in interpositional arthroplasty and implants have introduced new opportunities in giving a more functional outcome. This review will discuss how to approach hallux rigidus in a clinical setting and examine recent evidence in the available treatment options.