Hallux Rigidus: Cheilectomy, Osteotomy, Arthroplasty, and Arthrodesis
1. Hallux rigidus is a common pathology of the middle aged and is predominantly seen in women. 2. Typically the main presenting symptom on history is often pain at terminal heel rise just prior to toe-off. 3. The Coughlin and Shurnas classification is m
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Hallux Rigidus: Cheilectomy, Osteotomy, Arthroplasty, and Arthrodesis Matthew A. Mann, Om Prakash Sharma, Gilbert Yee, and Johnny T.C. Lau
Keywords
Hallux rigidus • 1st MTP arthritis • Cheilectomy • 1st MTP arthrodesis • Keller arthroplasty • Interpositional arthroplasty • Hemiarthroplasty
Introduction Hallux rigidus (HR) or osteoarthritis of the first metatarsophalangeal (MTP) joint is the most common form of osteoarthritis of the foot, affecting an estimated one in 40 adults over the age of 50 years [1]. Mean age at onset of symptoms is 51 years and incidence is higher in females [2, 3]. Ninety-five percent of the affected patients have a bilateral presentation [2]. It is one of the most common disorders of the first MTP joint, second only to hallux valgus [4–6]. It may result in
M.A. Mann, MDCM, FRCSC J.T.C. Lau, MD, MSC, FRCSC (*) Department of Orthopedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada e-mail: [email protected]; [email protected] O.P. Sharma, MBBS, MS, FRCSC Department of Orthopedic Surgery, Hospital For Sick Children, Toronto, ON, Canada e-mail: [email protected] G. Yee, MD, Med, MBA, FRCSC Department of Orthopedic Surgery, The Scarborough General Hospital, Scarborough, Toronto, ON, Canada e-mail: [email protected]
notable limitation in gait, activity level, and daily function. Various functional and structural deformities limit the normal sliding and gliding motions of the first MTP joint by producing plantar subluxation of the base of proximal phalanx in relation to the first metatarsal head. Impaction of the dorsal surface occurs with continued ambulation, which is associated with degenerative changes in the joint [6, 7]. This progressive joint destruction causes stiffness resulting in HR [4, 7]. The main objective of treatment of HR is to alleviate pain and improve the overall function of the patient. The literature focuses on surgical procedures, which range from simple cheilectomy to more complex osteotomies, arthrodesis, and joint arthroplasty. Nevertheless, considerable controversy remains surrounding the indications and outcomes of various procedures. The natural history of HR is relatively benign and not always associated with progression of symptoms. Smith and colleagues reviewed 22 patients treated nonoperatively for 12–19 years [8]. Sixty-seven percent of patients showed measurable loss of cartilage space radiographically over time, and 75 % of patients reported that they would still choose nonoperative treatment.
© Springer-Verlag Berlin Heidelberg 2016 H.-G. Jung (ed.), Foot and Ankle Disorders: An Illustrated Reference, DOI 10.1007/978-3-642-54493-4_2
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Etiology The etiology of HR remains unknown although many theories have been proposed. Traumatic events or osteochondritis dissecans may result in damage to the articular surface [9]. Hypermobility of the first metatarsal has been implicated [10]. Inflammatory or metabolic conditions such as gout, rheumatoid arthritis, and seronegative arthropathies have
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