Abstract
Hallux rigidus, Latin for Stiff Toe, is characterized by an osteoarthritic degeneration of the articular surfaces of the first metatarsophalangeal joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified operative procedures and the more up to date knowledge about non-operative and surgical treatment of hallux rigidus. This may provide current information for physicians, medschool attendants and researchers. A comprehensive literature search using PubMed database has been performed, up to April 1, 2017. Several different types of treatment are described in the literature for low-grade hallux rigidus. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. Hallux rigidus is a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment for low-grade forms should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
Similar content being viewed by others
References
Cotterill J (1888) Stiffness of the great toe in adolescents. BMJ 1:1158
Davies-Colley M (1887) Contraction of the metatarsophalangeal joint of the great toe. BMJ 1:728
Van Saase JL et al (1989) Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 48:271–280
Coughlin MJ et al (2003) Hallux rigidus: demographics, etiology and radiographic assessment. Foot Ankle Int 24:731–743
Hamilton WG et al (1997) Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int 18(2):68–70
Shereff MJ et al (1986) Kinematics of the first metatarsophalangeal joint. J Bone Joint Surg Am 68A(3):392–398
Hamid KS et al (2015) Clinical Presentation and management of hallux rigidus. Foot Ankle Clin 20:391–399
Lucas DE et al (2015) Hallux rigidus. Relevant Anatomy and Pathophysiology. Foot Ankle Clin 20:381–389
Regnauld B (1986) Disorders of the great toe. In: Elson R (ed) The foot: pathology, etiology, seminology, clinical investigation and treatment. Springer, Berlin, pp 269–281
Hattrup SJ et al (1988) Subjective results of hallux rigidus following treatment with cheilectomy. Clin Orthop Relat Res 226:182–191
Coughlin MJ et al (2003) Hallux rigidus: grading and long term results of operative treatment. J Bone Joint Surg Am 85:2072–2088
Beeson P et al (2008) Classification systems for hallux rigidus: a review of the literature. Foot Ankle Int 29:407–414
Kon Kam King C et al (2017) Comprehensive review of non-operative management of hallux rigidus. Cureus 9(1):e987
Shamus J et al (2004) The effect of sesamoid mobilization, flexor hallucis strenghtening, and gait training on reducing pain and restoring function in individuals with hallux limitus: a clinical trial. J Orthop Sports Phys Ther 34:368–376
Feltham GT et al (2001) Age-based outcomes of cheilectomy for the treatment of hallux rigidus. Foot Ankle Int 22(3):192–197
Mulier T et al (1999) Results after cheilectomy in athletes with hallux rigidus. Foot Ankle Int 20(4):232–237
Harrison MH et al (1963) Arthodesis for the first metatarsophalangeal joint for hallux valgus and rigidus. J Bone J Surg 45:471–480
Kennedy JG et al (2006) Outcomes after interpositional arthroplasty for treatment of hallux rigidus. Clin Orthop Relat Res 445:210–215
Pulavarti RS et al (2005) First metatarsophalangeal joint replacement using the Bio-Action great toe implant: intermediate results. Foot Ankle Int 26(12):1033–1037
Coughling MJ et al (2003) Hallux rigidus. J Bone Joint Surg Am 85:2072–2088
Nicolosi N et al (2015) Long-term follow-up of the cheilectomy for degenerative joint disease of the first metatarsophalangeal joint. J Foot Ankle Surg 54:1010–1020
Dawe ECJ, et al (2012) Early results of minimally invasive cheilectomy for painfull hallux rigidus. J Bone Joint Surg Br 94B(XXII):33
Morgan S, et al (2012) Minimally invasive cheilectomy: functional outcome and comparison with open cheilectomy. J Bone 94B(Supp)XLI:93
Mesa-Ramos M et al (2008) Evaluation of the treatment of hallux rigidus by percutaneous surgery. Acta Orthop Belg 74:222–226
Watanabe M, et al (1985) Equipments and procedures of small joint arthroscopy. In: Watanabe M (ed) Arthroscopy of small joints. Tokyo, etc: Igaku-Shoin 5:3–37
Bartlett DH (1988) Arthroscopic management of osteochondritis dissecans of the first metatarsal head. Arthroscopy 4:51–54
Davies MS, Saxby TS (1999) Arthroscopy of the metatarsophalangeal joint. J Bone Joint Surg Br 81B:203–206
Dijk Van et al (1998) Arthroscopic surgery of the metatarsophalangeal first joint. Arthroscopy 14(8):851–855
Iqbal MJ et al (1998) Arthroscopic cheilectomy for hallux rigidus. Arthroscopy 14(3):307–310
Kutucu E et al (2017) Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint. J Orthop Surg Res 12:68
Paczesny LM et al (2016) Ultrasound-guided arthroscopic management of hallux rigidus. Videosurgery Miniinv 11(3):144–148
Aldegheri R et al (1994) Articulated distraction of the hip: conservative surgery for arthritis in young patients. Clin Orthop Relat Res 301:94–101
Judet R et al (1978) The use of a hing distraction apparatus after arthrolysis and arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 64(5):353–365
Kluesner AJ et al (2009) Ankle arthrodiastasis. Clin Podiatr Med Surg 26:227–244
Talarico LM et al (2005) Management of hallux limitus with distraction of the first metatarsophalangeal joint. J Am Podiatr Med Assoc 95(2):121–129
Van Valburg AA et al (1998) Beneficial effects of intermittent fluid pressure of low physiological magnitude on cartilage and inflammation in osteoarthritis. An in vivo study. J Rheumatol 25(3):515–520
Abraham JS et al (2012) Hinged external fixation distraction for treatment of first metatarsophalangeal joint arthritis. J Foot Ankle Surg 51(5):604–612
Ramanujam CL et al (2012) First metatarsophalangeal joint arthrodiastasis and biologic resurfacing with external fixation: a case report. Clin Podiatr Med Surg 29:137–141
Inge GA et al (1933) Surgery of the sesamoid bones of the great toe. Arch Surg 27:466–489
Saxena A et al (2016) Return to activity after sesamoidectomy in athletically active individuals. Foot Ankle Int 24(5):415–419
Tagoe M et al (2009) Total sesamoidectomy for painful hallux rigidus: a medium-term outcome study. Foot Ankle Int 30(7):640–646
Bonney G et al (1952) Hallux valgus and hallux rigidus: a critical survey of operative results. J Bone Joint Surg Br 34(3):366–385
Kessel L et al (1958) Hallux rigidus in the adolescent. J Bone Joint Surg Br 40(4):668–673
Moberg E (1979) A simple operation for hallux rigidus. Clin Orthop Relat Res 142:55–56
Waizy H et al (2010) Mid- and long-term results of the joint preserving therapy of hallux ridigus. Arch Orthop Trauma Surg 130:165–170
Kilmartin TE (2005) Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients. J Foot Ankle Surg 44:2–12
Regnauld B (1986) The foot: pathology, aetiology, semiology, clinical investigation and therapy. In Elson R (ed) Springer, Berling, pp 335–350
Quinn M et al (1990) Keller arthroplasty with autogenous bone graft in the treatment of hallux valgus. J Foot Surg 29(3):284–291
Flavin R et al (2008) A finite-element analysis study of the metatarsophalangeal joint of the hallux rigidus. J Bone Joint Surg Br 90(10):1334–1340
Watermann H (1927) Die Arthritis Deformans des Grozehen-Grungelenkes als Selbstndiges Krankheitsbild. Z Orthop Chir 48:346–355
Youngswick FD (1982) Modifications of the Austin bunionectomy for treatment of metatarsus primus elevatus associated with hallux limitus. J Foot Surg 21(2):114–116
Gerbert J et al (2001) Youngswick-Austin procedure: the effect of plantar arm orientation on metatarsal head displacement. J Foot Ankle Surg 40(1):8–14
LaMar L et al (2006) Mechanical comparison of the Youngswick, Sagittal V and modified Weil osteotomies for hallux rigidus in a sawbone model. J Foot Ankle Surg 45(2):70–75
Oloff LM et al (2006) A retrospective analysis of joint salvage procedures for grades III and IV hallux rigidus. J Foot Ankle Surg 47:230–236
Giannini S et al (2004) What’s new in surgical options for hallux rigidus? J Bone Joint Surg Am 86(2):72–83
Seibert NR et al (2009) Surgical management of hallux rigidus: cheilectomy and osteotomy (phalanx and metatarsal). Foot Ankle Clin 14:9–22
Viegas GV (1998) Reconstruction of hallux limitus deformity using a first metatarsal sagittal-Z osteotomy. J Foot Ankle Surg 37(3):204–211
Lundeen RO et al (2000) Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus. J Foot Ankle Surg 39:161–167
Ronconi et al (2000) Distal oblique osteotomy of the first metatarsal for the correction of hallux limitus and rigidus deformity. J Foot Ankle Surg 39(3):154–160
Malerba et al (2008) Distal oblique first metatarsal osteotomy in grade III hallux rigidus: a long-term follow-up. Foot Ankle Int 29:677–682
Drago JJ et al (1984) A comprehensive review of hallux limitus. J Foot Ankle Surg 23:213–220
Vannini F et al (2016) Treatment of osteochondral lesions of the talus in athletes: what is the evidence? Joints 4(2):111–120
Easley ME et al (2010) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? J Am Acad Orthop Surg 18:616–630
Debnath UK et al (2006) Indications for and technique of first metatarsal joint arthroscopy. Foot Ankle Int 27(12):1049–1054
Mithofer K et al (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87(9):1911–1920
Mithoefer K et al (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063
Bojanic I et al (2011) Osteochondritis dissecans of the first metatarsophalangeal joint: arthroscopy and microfracture technique. J Foot Ankle Surg 50(5):623–625
Ritsila V et al (1994) Periosteal and perichondral grafting in reconstructive surgery. Clin Orthop Relat Res 302:259–265
Jamora H et al (1987) Reconstruction on patellar cartilage defects with free periosteal grafts. Scand J Plast Reconstr Surg 21:175
Ritsila V et al (1992) Periosteal resurfacing of the metatarsal head in hallux rigidus and Freiberg’s disease. J Orthop Rheum 5:79–84
Giannini S et al (2005) Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 87(2):28–41
Saris D et al (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36(2):235–246
Marlovits S et al (2005) Early post-operative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle. Knee Surg Sports Traumatol Arthrosc 13(6):451–457
Brittberg M (2010) Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sport Med 38(6):1259–1271
Baumhauer JF et al (2016) Prospective, randomized, multi-centered clinical trial assessing safety and efficacy of a synthetic cartilage implant versus first metatarsophalangeal arthrodesis in advanced hallux rigidus. Foot Ankle Int 37(5):457–469
Acknowledgements
Authors would like to thank Dr. Maria Pia Cumani from Scuola di Disegno Anatomico, Rizzoli Orthopaedic Institute (Bologna, Italy) for artwork and figures. All Authors were fully involved in the study and the preparation of the manuscript, and the material within has not been and will not be submitted for publication elsewhere.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Caravelli, S., Mosca, M., Massimi, S. et al. A comprehensive and narrative review of historical aspects and management of low-grade hallux rigidus: conservative and surgical possibilities. Musculoskelet Surg 102, 201–211 (2018). https://doi.org/10.1007/s12306-018-0530-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-018-0530-3