Advertisement

Surgical options for hallux rigidus: state of the art and review of the literature

  • 253 Accesses

Abstract

Hallux rigidus is a painful condition of the great toe characterized by restriction of the metatarsophalangeal range of motion and progressive osteophyte formation. Many etiologies have been postulated including excessive length of the first ray, trauma, abnormally elevated first metatarsal and a positive family history. However, most cases are likely idiopathic. Plain radiographs are used to grade the severity of hallux rigidus. The more comprehensive grading is represented by Coughlin and Shurnas’ system that introduced a four-grade classification. When nonoperative treatment fails to provide relief, surgery should be performed. The goal of surgery is to relieve pain, maintain stability of the first metatarsophalangeal joint and improve function and quality of life. Operative treatments can be divided into joint sparing (e.g., cheilectomy with or without associated osteotomies) versus joint sacrificing (e.g., arthroplasty or arthrodesis). There are a variety of osteotomies available for treatment of hallux rigidus (phalanx and/or metatarsal osteotomies). Newer techniques of interpositional arthroplasty as well as new hemi-arthroplasty designs, including synthetic cartilage implants, offer promising options for preservation of motion. The choice of procedure is based on the condition of the joint, patient’s goals and expectations of the surgical outcome, and patient’s motivation. This article discusses various procedures along with clinical outcomes and complications. The advantages and disadvantages of each procedure are discussed.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

References

  1. 1.

    Davies-Colley M (1887) Contraction of the metatarsophalangeal joint of the great toe. BMJ 1:728

  2. 2.

    Ho B, Baumhauer J (2017) Hallux rigidus. EFORT Open Rev 2:13–20. https://doi.org/10.1302/2058-5241.2.160031

  3. 3.

    Lam A, Chan JJ, Surace MF, Vulcano E (2017) Hallux rigidus: How do I approach it? World J Orthop 8:364–371. https://doi.org/10.5312/wjo.v8.i5.364

  4. 4.

    Shereff MJ, Bejjani FJ, Kummer FJ (1986) Kinematics of the first metatarsophalangeal joint. J Bone Jt Surg Am 68:392–398

  5. 5.

    Botek G, Anderson MA (2011) Etiology, pathophysiology, and staging of hallux rigidus. Clin Podiatr Med Surg 28(229–243):vii. https://doi.org/10.1016/j.cpm.2011.02.004

  6. 6.

    Migues A, Slullitel G (2012) Joint-preserving procedure for moderate hallux rigidus. Foot Ankle Clin 17:459–471. https://doi.org/10.1016/j.fcl.2012.06.006

  7. 7.

    Hamid KS, Parekh SG (2015) Clinical presentation and management of hallux rigidus. Foot Ankle Clin 20:391–399. https://doi.org/10.1016/j.fcl.2015.04.002

  8. 8.

    Karasick D, Wapner KL (1991) Hallux rigidus deformity: radiologic assessment. AJR Am J Roentgenol 157:1029–1033. https://doi.org/10.2214/ajr.157.5.1927789

  9. 9.

    Karasick D, Wapner KL (1990) Hallux valgus deformity: preoperative radiologic assessment. AJR Am J Roentgenol 155:119–123. https://doi.org/10.2214/ajr.155.1.2112832

  10. 10.

    Coughlin MJ, Shurnas PS (2003) Hallux rigidus. Grading and long-term results of operative treatment. J Bone Jt Surg Am 85:2072–2088

  11. 11.

    Duvries HL (1959) Surgery of the foot. Acad Med 34:1055

  12. 12.

    Nicolosi N, Hehemann C, Connors J, Boike A (2015) Long-term follow-up of the cheilectomy for degenerative joint disease of the first metatarsophalangeal joint. J Foot Ankle Surg 54:1010–1020. https://doi.org/10.1053/j.jfas.2014.12.035

  13. 13.

    Bauer T (2014) Percutaneous forefoot surgery. Orthop Traumatol Surg Res 100:S191–S204. https://doi.org/10.1016/j.otsr.2013.06.017

  14. 14.

    Hunt KJ (2015) Hallux metatarsophalangeal (MTP) joint arthroscopy for hallux rigidus. Foot Ankle Int 36:113–119. https://doi.org/10.1177/1071100714559728

  15. 15.

    Walter R, Perera A (2015) Open, arthroscopic, and percutaneous cheilectomy for hallux rigidus. Foot Ankle Clin 20:421–431. https://doi.org/10.1016/j.fcl.2015.04.005

  16. 16.

    Seibert NR, Kadakia AR (2009) Surgical management of hallux rigidus: cheilectomy and osteotomy (phalanx and metatarsal). Foot Ankle Clin 14:9–22. https://doi.org/10.1016/j.fcl.2008.11.002

  17. 17.

    Bonney G, Macnab I (1952) Hallux valgus and hallux rigidus: a critical survey of operative results. J Bone Jt Surg Br 34:366–385

  18. 18.

    Waizy H, Czardybon MA, Stukenborg-Colsman C et al (2010) Mid- and long-term results of the joint preserving therapy of hallux rigidus. Arch Orthop Trauma Surg 130:165–170. https://doi.org/10.1007/s00402-009-0857-1

  19. 19.

    Freeman BL, Hardy MA (2011) Multiplanar phalangeal and metatarsal osteotomies for hallux rigidus. Clin Podiatr Med Surg 28:329–344. https://doi.org/10.1016/j.cpm.2011.03.002

  20. 20.

    Watermann H (1927) Die Arthritis deformans des grozehen-grungelenkes als selbstndiges krankheitsbild. Z Orthop Chir 48:346–355

  21. 21.

    Youngswick FD (1982) Modifications of the Austin bunionectomy for treatment of metatarsus primus elevatus associated with hallux limitus. J Foot Surg 21:114–116

  22. 22.

    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. https://doi.org/10.1053/j.jfas.2004.11.013

  23. 23.

    Lundeen RO, Rose JM (2000) Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus. J Foot Ankle Surg 39:161–167

  24. 24.

    Ronconi P, Monachino P, Baleanu PM, Favilli G (2000) Distal oblique osteotomy of the first metatarsal for the correction of hallux limitus and rigidus deformity. J Foot Ankle Surg 39:154–160

  25. 25.

    Malerba F, Milani R, Sartorelli E, Haddo O (2008) Distal oblique first metatarsal osteotomy in grade 3 hallux rigidus: a long-term followup. Foot Ankle Int 29:677–682. https://doi.org/10.3113/FAI.2008.0677

  26. 26.

    Viegas GV (1998) Reconstruction of hallux limitus deformity using a first metatarsal sagittal-Z osteotomy. J Foot Ankle Surg 37:204–211 (discussion 261-262)

  27. 27.

    Drago JJ, Oloff L, Jacobs AM (1984) A comprehensive review of hallux limitus. J Foot Surg 23:213–220

  28. 28.

    Harisboure A, Joveniaux P, Madi K, Dehoux E (2009) The Valenti technique in the treatment of hallux rigidus. Orthop Traumatol Surg Res 95:202–209. https://doi.org/10.1016/j.otsr.2009.02.004

  29. 29.

    Colò G, Alessio-Mazzola M, Dagnino G, Felli L (2019) Long-term results of surgical treatment of valenti procedures for hallux rigidus: a minimum ten-year follow-up retrospective study. J Foot Ankle Surg 58:291–294. https://doi.org/10.1053/j.jfas.2018.08.055

  30. 30.

    Coutts A, Kilmartin TE, Ellis MJH (2012) The long-term patient focused outcomes of the Keller’s arthroplasty for the treatment of hallux rigidus. Foot (Edinb) 22:167–171. https://doi.org/10.1016/j.foot.2012.02.008

  31. 31.

    McNeil DS, Baumhauer JF, Glazebrook MA (2013) Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int 34:15–32. https://doi.org/10.1177/1071100712460220

  32. 32.

    Politi J, John H, Njus G et al (2003) First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability. Foot Ankle Int 24:332–337. https://doi.org/10.1177/107110070302400405

  33. 33.

    Fanous RN, Ridgers S, Sott AH (2014) Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg 20:170–173. https://doi.org/10.1016/j.fas.2014.03.004

  34. 34.

    Bauer T (2017) Percutaneous first metatarsophalangeal joint fusion. Open Orthop J 11:724–731. https://doi.org/10.2174/1874325001711010724

  35. 35.

    Chraim M, Bock P, Alrabai HM, Trnka H-J (2016) Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. Int Orthop 40:2401–2408. https://doi.org/10.1007/s00264-016-3277-1

  36. 36.

    Gibson JNA, Thomson CE (2005) Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int 26:680–690. https://doi.org/10.1177/107110070502600904

  37. 37.

    Raikin SM, Ahmad J, Pour AE, Abidi N (2007) Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Jt Surg Am 89:1979–1985. https://doi.org/10.2106/JBJS.F.01385

  38. 38.

    Stone OD, Ray R, Thomson CE, Gibson JNA (2017) Long-term follow-up of arthrodesis vs. total joint arthroplasty for hallux rigidus. Foot Ankle Int 38:375–380. https://doi.org/10.1177/1071100716682994

  39. 39.

    Rammelt S, Panzner I, Mittlmeier T (2015) Metatarsophalangeal joint fusion: Why and how? Foot Ankle Clin 20:465–477. https://doi.org/10.1016/j.fcl.2015.04.008

  40. 40.

    Ellington JK, Jones CP, Cohen BE et al (2010) Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int 31:385–390. https://doi.org/10.3113/FAI.2010.0385

  41. 41.

    Baumhauer JF, Singh D, Glazebrook M 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 37:457–469. https://doi.org/10.1177/1071100716635560

  42. 42.

    Johnson MD, Brage ME (2016) Total toe replacement in the United States: what is known and what is on the horizon. Foot Ankle Clin 21:249–266. https://doi.org/10.1016/j.fcl.2016.01.004

  43. 43.

    Weil LS, Pollak RA, Goller WL (1984) Total first joint replacement in hallux valgus and hallux rigidus. Long-term results in 484 cases. Clin Podiatry 1:103–129

  44. 44.

    Horisberger M, Haeni D, Henninger HB et al (2016) Total arthroplasty of the metatarsophalangeal joint of the hallux. Foot Ankle Int 37:755–765. https://doi.org/10.1177/1071100716637901

  45. 45.

    Gheorghiu D, Coles C, Ballester J (2015) Hemiarthroplasty for hallux rigidus: mid-term results. J Foot Ankle Surg 54:591–593. https://doi.org/10.1053/j.jfas.2014.11.001

  46. 46.

    Voskuijl T, Onstenk R (2015) Operative treatment for osteoarthritis of the first metatarsophalangeal joint: arthrodesis versus hemiarthroplasty. J Foot Ankle Surg 54:1085–1088. https://doi.org/10.1053/j.jfas.2015.06.019

  47. 47.

    Stibolt RD, Patel HA, Lehtonen EJ et al (2019) Hemiarthroplasty versus total joint arthroplasty for hallux rigidus: a systematic review and meta-analysis. Foot Ankle Spec 12:181–193. https://doi.org/10.1177/1938640018791017

  48. 48.

    Patel HA, Kalra R, Johnson JL et al (2018) Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? A systematic review and meta-analysis. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2018.07.006

  49. 49.

    Lau JT, Daniels TR (2001) Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus. Foot Ankle Int 22:462–470

  50. 50.

    Coughlin MJ, Shurnas PJ (2003) Soft-tissue arthroplasty for hallux rigidus. Foot Ankle Int 24:661–672. https://doi.org/10.1177/107110070302400902

  51. 51.

    Cassinelli SJ, Chen S, Charlton TP, Thordarson DB (2019) Early outcomes and complications of synthetic cartilage implant for treatment of hallux rigidus in the United States. Foot Ankle Int. https://doi.org/10.1177/1071100719855049

  52. 52.

    Glazebrook M, Blundell CM, O’Dowd D et al (2019) Midterm outcomes of a synthetic cartilage implant for the first metatarsophalangeal joint in advanced hallux rigidus. Foot Ankle Int 40:374–383. https://doi.org/10.1177/1071100718815469

Download references

Acknowledgements

The authors thank Dr. P. Pasquier M.D. for preparation of the figures.

Author information

Correspondence to Laurent Galois.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest with this manuscript.

Ethical standards

This study complies with the current laws of the country in which it was conducted.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Galois, L., Hemmer, J., Ray, V. et al. Surgical options for hallux rigidus: state of the art and review of the literature. Eur J Orthop Surg Traumatol 30, 57–65 (2020) doi:10.1007/s00590-019-02528-x

Download citation

Keywords

  • Hallux rigidus
  • Osteoarthritis
  • First metatarsophalangeal joint
  • Joint preserving
  • Osteotomy
  • Arthroplasty