Hallux rigidus

St. Alphonsus Regional Medical Center, Boise, ID, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 09/2004; 86-A Suppl 1(Pt 2):119-30.
Source: PubMed


There have been few long-term studies documenting the outcome of surgical treatment of hallux rigidus. The purposes of this report were to evaluate the long-term results of the operative treatment of hallux rigidus over a nineteen-year period in one surgeon's practice and to assess a clinical grading system for use in the treatment of hallux rigidus.
All patients in whom degenerative hallux rigidus had been treated with cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and who were alive at the time of this review were identified and invited to return for a follow-up evaluation. At this follow-up evaluation, the hallux rigidus was graded with a new five-grade clinical and radiographic system. Outcomes were assessed by comparison of preoperative and postoperative pain and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of motion. These outcomes were then correlated with the preoperative grade and the radiographic appearance at the time of follow-up.
One hundred and ten of 114 patients with a diagnosis of hallux rigidus returned for the final evaluation. Eighty patients (ninety-three feet) had undergone a cheilectomy, and thirty patients (thirty-four feet) had had an arthrodesis. The mean duration of follow-up was 9.6 years after the cheilectomies and 6.7 years after the arthrodeses. There was significant improvement in dorsiflexion and total motion following the cheilectomies (p = 0.0001) and significant improvement in postoperative pain and AOFAS scores in both treatment groups (p = 0.0001). A good or excellent outcome based on patient self-assessment, the pain score, and the AOFAS score did not correlate with the radiographic appearance of the joint at the time of final follow-up. Dorsiflexion stress radiographs demonstrated correction of the elevation of the first ray to nearly zero. There was no association between hallux rigidus and hypermobility of the first ray, functional hallux limitus, or metatarsus primus elevatus.
Ninety-seven percent (107) of the 110 patients had a good or excellent subjective result, and 92% (eighty-six) of the ninety-three cheilectomy procedures were successful in terms of pain relief and function. Cheilectomy was used with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with <50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis.

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    • "Cheilectomy is presently the standard operative procedure performed to treat "hallux rigidus" if the loss of articular cartilage is limited to the dorsal parts of the joint and pain persists after conservative treatment [1]. In this procedure, the dorsal third of the articular surface of both joint partners is removed. "
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    ABSTRACT: Walking down stairs is a clinically relevant daily activity for older persons. The aim of this pilot study was to investigate the impact of cheilectomy on walking on level ground and on stairs. 3D motion analysis of foot kinematics was performed in eight patients with hallux rigidus and 11 healthy control participants with a 12-camera system, using the Heidelberg foot measurement method before and one year after surgery. The clinical results were documented using the AOFAS Scale. The range of motion of the first metatarsophalangeal joint did not improve after the operation under any gait condition. Preoperatively, hallux dorsi-/plantarflexion in level walking was 11.9[degree sign] lower in patients than in controls (p = 0.006), postoperatively 14.5[degree sign] lower (p = 0.004). Comparing walking conditions in patients, hallux dorsi-/plantarflexion was significantly higher in level walking than in climbing stairs (difference up stairs - level: -8.1[degree sign], p = 0.018).The AOFAS Scale improved significantly from 56.9 +/- 19.9 points (mean +/- SD), preoperatively, to 75.9 +/- 13.9 points, postoperatively (p = 0.027). Cheilectomy is appropriate for reducing symptoms of hallux rigidus. However, neither a positive influence on the range of motion in walking on level ground and on stairs nor a functional improvement was observed in this group of patients.Trial registration: NCT01804491.
    Journal of Foot and Ankle Research 02/2014; 7(1):13. DOI:10.1186/1757-1146-7-13 · 1.46 Impact Factor
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    • "Arthrodesis is an option for moderate to severe joint involvement or the patients with active lifestyle [16]. Patients with grade-4 hallux rigidus or grade-3 hallux rigidus with less than 50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis [17]. Keller procedure is a resection arthroplasty advised in severely damaged first MTP or the older patients with less functional demands as it provides early symptomatic relief and needs minimal postoperative rehabilitation [9]. "
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    ABSTRACT: Background. Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. Objective. Aim of the present paper was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. Methods. To view the hallux rigidus and its rehabilitation, a webbased published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in August 2010 using 4 specific keywords "hallux rigidus, physical therapy, chiropractic, and manual therapy" typed in exactly same manner in the search column of the databases. Result. the review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic, or physiotherapeutic management of the hallux rigidus. Conclusion. Review conclude that conservative programs for hallux rigidus consists of comprehensive intervention program that includes great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long MTP joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus.
    09/2012; 2012(6):479046. DOI:10.1155/2012/479046

  • Gait & Posture 12/2006; 24. DOI:10.1016/j.gaitpost.2006.11.159 · 2.75 Impact Factor
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