Hallux rigidus: How do I approach it?

Hallux rigidus is a degenerative disease of the first
metatarsalphalangeal (MTP) joint and affects 2.5% of
people over age 50. Dorsal osteophytes and narrowed
joint space leads to debilitating pain and limited range of
motion. Altered gait mechanics often ensued as 119%
of the body force transmit through the 1st MTP joint
during gait cycle. Precise etiology remains under debate
with trauma being often cited in the literature. Hallux
valgus interphalangeus, female gender, inflammatory
and metabolic conditions have all been identified as
associative factors. Clinical symptoms, physical exam
and radiographic evidence are important in assessing
and grading the disease. Non-operative managements
including nonsteroidal antiinflammatory drugs, intraarticular
injections, shoe modification, activity modification
and physical therapy, should always be attempted for all
hallux rigidus patients. The goal of surgery is to relieve
pain, maintain stability of the first MTP joint, and improve
function and quality of life. Operative treatments can
be divided into joint-sparing versus joint-sacrificing.
Cheilectomy and moberg osteotomy are examples of
joint-sparing techniques that have demonstrated great
success in early stages of hallux rigidus. Arthrodesis is a
joint-sacrificing procedure that has been the gold standard
for advanced hallux rigidus. Other newer procedures such
as implant arthro­plasty, interpositional arthroplasty and
arthroscopy, have demonstrated promising early patient
outcomes. However, future studies are still needed to
validate its long-term efficacy and safety. The choice of
procedure should be based on the condition of the joint,
patient’s goal and expectations, and surgeon’s experience
with the technique.