Lapidus Arthrodesis Plus Osteochondral Autograft Transplantation in the Management of Hallux Rigidus With an Elevated First Ray

2013 ◽  
Vol 7 (2) ◽  
pp. 135-139
Author(s):  
Kajetan Klos ◽  
Paul Simons
Keyword(s):  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Joint Function ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transplantation ◽  
First Ray ◽  
Transplantation Technique ◽  
Novel Method

The range of joint-sparing treatments for advanced hallux rigidus is still very limited. The authors describe an osteochondral autograft transplantation technique combined with Lapidus arthrodesis as a novel method of obtaining a relatively symptom-free first metatarsophalangeal joint function in patients with hallux rigidus and first-ray elevation. Level of Evidence: Level V

scholarly journals Sensitivity and Specificity of the Functional Hallux Limitus Test to Predict Foot Function

2002 ◽  
Vol 92 (5) ◽  
pp. 269-271 ◽  
Author(s):  
Craig Payne ◽  
Vivienne Chuter ◽  
Kathryn Miller
Keyword(s):  
Sensitivity And Specificity ◽  
Metatarsophalangeal Joint ◽  
Clinical Test ◽  
Joint Function ◽  
Compensatory Mechanisms ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Ray ◽  
Foot Function ◽  
Midtarsal Joint

Functional hallux limitus is an underrecognized entity that generally does not produce symptoms but can result in a variety of compensatory mechanisms that can produce symptoms. Clinically, hallux limitus can be determined by assessing the range of motion available at the first metatarsophalangeal joint while the first ray is prevented from plantarflexing. The aim of this study was to determine the sensitivity and specificity of this clinical test to predict abnormal excessive midtarsal joint function during gait. A total of 86 feet were examined for functional hallux limitus and abnormal pronation of the midtarsal joint during late midstance. The test had a sensitivity of 0.72 and a specificity of 0.66, suggesting that clinicians should consider functional hallux limitus when there is late midstance pronation of the midtarsal joint during gait. (J Am Podiatr Med Assoc 92(5): 269-271, 2002)

Position of the first ray and motion of the first metatarsophalangeal joint

1996 ◽  
Vol 86 (11) ◽  
pp. 538-546 ◽  
Author(s):  
TS Roukis ◽  
PR Scherer ◽  
CF Anderson
Keyword(s):  
Quantitative Analysis ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
First Ray

The authors present a quantitative analysis of the effect that first ray position has on motion of the first metatarsophalangeal joint. A goniometer was constructed to measure the degrees of first metatarsophalangeal joint dorsiflexion with the first ray in three positions: weightbearing resting position, dorsiflexed 4 mm from the weightbearing resting position, and dorsiflexed 8 mm from the weightbearing resting position. First metatarsophalangeal joint dorsiflexion decreased 19% as the first ray was moved from the weightbearing resting position to 4 mm dorsiflexed, 19.3% as the first ray was moved from 4 mm dorsiflexed to 8 mm dorsiflexed, and 34.7% as the first ray was moved from the weightbearing resting position to 8 mm dorsiflexed. The biomechanical significance of decreased first metatarsophalangeal joint dorsiflexion that results from first ray dorsiflexion is discussed, and proposed bases for the pathomechanics of hallux abducto valgus and hallux rigidus deformities are presented.

scholarly journals Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141881442 ◽  
Author(s):  
Brendan R. Emmons ◽  
Dominic S. Carreira
Keyword(s):  
Systematic Review ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Cochrane Central Register ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Number Of Patients ◽  
Long Term Follow Up

Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies

scholarly journals Comparison of Complication and Reoperation Rates for Minimally Invasive Versus Open Cheilectomy of the First Metatarsophalangeal Joint

2019 ◽  
Vol 41 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Richard Stevens ◽  
Matthew Bursnall ◽  
Carolyn Chadwick ◽  
Howard Davies ◽  
Mark Flowers ◽  
...  
Keyword(s):  
Relative Risk ◽  
Minimally Invasive ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Open Group ◽  
Recurrent Pain ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Published Evidence ◽  
Reoperation Rates

Background: Dorsal cheilectomy of the first metatarsophalangeal joint is an accepted treatment to alleviate dorsal impingement, pain, and reduced dorsiflexion in hallux rigidus. Traditionally performed via an open incision, this procedure has more recently been performed using minimally invasive techniques despite limited supportive published evidence. Methods: From December 2012 through December 2017, a retrospective analysis of all cheilectomies performed in our institution was done. The surgical technique was recorded along with any subsequent procedures performed for either persistent or recurrent pain, and complications were also noted. A comparison between open and minimally invasive outcomes was performed. In total, 171 cheilectomies were performed during this period. There were 38 open and 133 minimally invasive procedures. Results: At a mean 3-year follow-up, the reoperation rates of the 2 groups were different with only 1 (2.6%) of the open group requiring a fusion, while 17 (12.8%) of the minimally invasive surgical (MIS) group required further surgery (relative risk, 4.86; P = .059). In the open group, there was 1 (2.6%) complication, compared with 15 (11.3%) in the minimally invasive group (relative risk, 4.29; P = .076). Conclusion: While patients may opt for MIS cheilectomy with a proposed faster recovery time and better cosmesis, they should be counseled about the risks and benefits of both methods, and that the technique of MIS cheilectomy utilized in this study appears to have an increased relative risk of requiring a further procedure. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Concept, etiology, and pathomechanics of hallux rigidus

2021 ◽  
Vol 15 (3) ◽  
pp. 193-197
Author(s):  
Manuel Monteagudo de la Rosa ◽  
Ramón Viladot-Pericé
Keyword(s):  
Positive Impact ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Compensatory Mechanisms ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Functional Changes ◽  
Hallux Limitus ◽  
Sliding Mechanism ◽  
Movement Mechanism

There is a continuous anatomical, functional and pathomechanical roadmap from functional hallux limitus to hallux rigidus. Although many etiologies for hallux rigidus have been studied it is very probable that it has a primary origin with less-than-ideal movement when we are born. Upon a restricted range of motion, symptoms may arise depending on the amount of work and how compensatory mechanisms work around the first metatarsophalangeal joint. Changes occurring at the joint that allow the transition from a sliding movement mechanism (physiological) to a rolling mechanism (pathological) may trigger anatomical and functional changes resulting in pain and dysfunction. Any surgical technique that is able to restore the sliding mechanism to the first metatarsophalangeal joint will have a positive impact on pain and function in a patient with a symptomatic functional hallux limitus/rigidus. Level of Evidence V; Therapeutic Study; Expert opinion.

Midterm Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus

2018 ◽  
Vol 40 (4) ◽  
pp. 374-383 ◽  
Author(s):  
Mark Glazebrook ◽  
Chris M. Blundell ◽  
Dominic O’Dowd ◽  
Dishan Singh ◽  
Gwyneth de Vries ◽  
...  
Keyword(s):  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Implant Removal ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Patient Reported ◽  
Pain Visual Analog Scale ◽  
Safety Parameters ◽  
Clinically Significant

Background: A prospective, randomized, noninferiority clinical trial of synthetic cartilage implant hemiarthroplasty for hallux rigidus demonstrated functional outcomes and safety equivalent to first metatarsophalangeal (MTP) joint arthrodesis at 24 months. We prospectively assessed safety and efficacy outcomes for synthetic cartilage implant hemiarthroplasty at a minimum of 5 years. Methods: Of 135 eligible patients from the original trial, 112 (83.0%) were enrolled (mean age, 58.2 ± 8.8 years; 87 females). Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), and FAAM Sports subscales were completed preoperatively and 2 and 5 years postoperatively. Great toe active dorsiflexion, weightbearing radiographs, secondary procedures, and safety parameters were also evaluated. Results: At 24 months, 14/152 (9.2%) patients had undergone implant removal and conversion to arthrodesis. In years 2 to 5, 9/119 (7.6%) patients underwent implant removal and conversion to arthrodesis. At mean 5.8 ± 0.7 (range, 4.4-8.0) years’ follow-up, pain VAS, FAAM ADL, and FAAM Sports scores improved by 57.9 ± 18.6 points, 33.0 ± 17.6 points, and 47.9 ± 27.1 points, respectively, from baseline. Clinically significant changes in VAS pain, FAAM ADL, and FAAM Sports were reported by 103/106 (97.2%), 95/105 (90.5%), and 97/104 (93.3%) patients, respectively. Patient-reported outcomes at 24 months were maintained at 5.8 years in patients who were not revised. Active MTP joint peak dorsiflexion was maintained. Ninety-nine of 106 (93.4%) patients would have the procedure again. Conclusion: Clinical and safety outcomes for synthetic cartilage implant hemiarthroplasty observed at 2 years were maintained at 5.8 years. The implant remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. Level of Evidence: Level IV, case series.

scholarly journals Percutaneous First Metatarsophalangeal Joint Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 724-731 ◽  
Author(s):  
Thomas Bauer
Keyword(s):  
Simple Procedure ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Full Weight Bearing ◽  
Normal Walking ◽  
First Metatarsophalangeal Joint ◽  
Joint Fusion ◽  
Forefoot Surgery ◽  
First Ray

The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.

Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait

2006 ◽  
Vol 96 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Paul R. Scherer ◽  
Jennifer Sanders ◽  
Denten E. Eldredge ◽  
Susan J. Duffy ◽  
Ryan Y. Lee
Keyword(s):  
Hallux Valgus ◽  
Maximum Degree ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Foot Orthoses ◽  
First Metatarsophalangeal Joint ◽  
First Ray ◽  
And Gender ◽  
Midtarsal Joint ◽  
The Relationship

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)

scholarly journals Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

2020 ◽  
Vol 5 (2) ◽  
pp. 247301142093000 ◽  
Author(s):  
Jensen K. Henry ◽  
Andrew Kraszewski ◽  
Lauren Volpert ◽  
Elizabeth Cody ◽  
Howard Hillstrom ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Clinical Results ◽  
Hallux Rigidus ◽  
Wedge Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Pain Symptoms ◽  
Flexibility Parameters

Background: Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods: This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results: Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion: Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence: Level II, prospective comparative study.

scholarly journals Metatarsophalangeal arthroscopy of the hallux

2019 ◽  
Vol 13 (2) ◽  
pp. 119-123
Author(s):  
Maria Augusta Back Nascimento ◽  
Anna Carolina Coelho Nogueira ◽  
Carlos Daniel Cândido de Castro Filho ◽  
André Vitor Kerber Cavalcante Lemos ◽  
Mário Sérgio Paulillo de Cillo ◽  
...  
Keyword(s):  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Modified Technique ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Nylon Mesh ◽  
Before And After ◽  
Traction Device

Objective: This study sought to describe a modified arthroscopic technique in which a traction device with a horizontal vector and nylon mesh are used to allow continuous and uniform distraction without requiring an assistant surgeon to perform manual traction. Methods: Nine patients (seven females and two males; mean age 31.8 [30-52] years) with an indication for treatment of this joint who had been diagnosed with different pathologies, including synovitis, hallux vagus, and hallux rigidus, were selected and underwent arthroscopy of the first metatarsophalangeal joint using this modified technique. Results: Patient evaluations determined using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale were recorded before and after surgery. The mean scores before and after the procedure were 43.66 (32-55) and 95.22 (90-8), respectively. No scars or joint complications were observed at a six-month follow-up, and all subjects experienced rapid recovery and quickly returned to daily functions. Conclusion: Similarly to conventional arthroscopy of the metatarsophalangeal joint, the modified technique produced satisfactory surgical outcomes; moreover, this technique reduced surgical time and improved the surgeon’s autonomy by obviating the need for an assistant surgeon to perform traction. Level of Evidence IV; Therapeutic Studies; Case Series.

Sign in / Sign up

Export Citation Format

Share Document