Hallux Rigidus

What is Hallux Limitus and Hallux Rigidus?

Metatarsophalangeal joint is at the base of the great toe. Hallux limitus - is a condition characterized by pain and limited motion of this joint and can be seen as early arthritis. It may progress to Hallux Rigidus - a condition where the joint looses most of the motion.

What is the initial treatment?

Initial treatment involves rigid insoles, rigid sole shoes, steroid injection, pain killers and activity modification. With failed non operative treatment for at least 3 months, surgery can be considered.

What are the surgical options for Hallux limitus?

Dorsal cheilectomy is a procedure where the bony prominence is surgically removed to allow greater and less painful movement

It can be performed as open procedure but arthroscopic procedure has Advantages over open:

- small incision

- less postoperative pain

- quicker wound healing

- shoes can be worn 7-10 days after surgery

- x8 maginified view allows quality assessment of the joint and precision procedure

Procedures that can be performed concomitantly:

• debridement - loose cartilage flaps, excess of scar tissue removed with special instrument called dissector, shaving and sucking debris out at the same time

• Microfractures: bone found under damaged cartilage is perforated with sharp surgical owl in order for it to bleed and form scar like tissue called fibrocartilage

A study published by Hickey et all in the European Journal of Orthopaedic surgery and Traumatology in 2020, reported 4 year outcomes of 36 patients following MIS arthroscopic cheilectomy.

• Thirty patients (83%) reported they would recommend the procedure.

• Mean postoperative improvement in pain was 69% (range 0-100).

• Twenty-seven (84%) of patients reported either no pain (28%) or mild pain (56%).

• For patients who reported any pain, the mean pain experienced was rated as 3.4 out of 10 (range 1-9).

• Twenty-nine (81%) patients reported they could wear a 'fashionable' shoe postoperatively.

Risks of this procedure are relatively very low and include:

• Infection,

• nerve damage that may result in numb toe,

• tendon damage that may result in drooping toe,

• ongoing arthritis (progressing pain and stiffness),

• need for further surgery often in the form of decomperrive osteotomy, or fusion. It will be shown in the future video

https://pubmed.ncbi.nlm.nih.gov/32424474/

Aftercare:

- surgical shoe is worn 7-14 days

- weight bearing as tolerated is allowed immediately after surgery

- elevation to heart level 23hr a day is recommended for 1 week

- movement of the toe by hand or actively is commenced as soon as pain allows - 3-5 days after surgery

- return to light sports like cycling and swimming after 2 weeks

- return to jogging at 6 weeks

- return to contact or team sports at 12 weeks

- full recovery is about 6 months, but can last up to 12 months

Percutaneous Treatment