Hallux rigidus

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Hallux rigidus or stiff toe are degenerative arthritis and stiffness due to bone spurs affecting the MTP joint at the base of hallux.

Hallux flexus was originally described by Davies-Colley in 1887 as a phalanx plantar flexion post relative to the metatarsal head. At the same time, Cotterill first used the term hallux rigidus .

Video Hallux rigidus

Signs and symptoms

• Pain and joint stiffness at the base of the big toe when used (walking, standing, bending, etc.)
• Difficulty with certain activities (running, squatting)
• Swelling and inflammation around joints

Although the condition is degenerative, can occur in patients who are relatively young, especially active sportsmen who have experienced trauma to the joint (turf toe). An important example is NBA star Shaquille O'Neal who returned to basketball after surgery.

Maps Hallux rigidus

Cause

This condition, which occurs in adolescents and adults, can be attributed to previous trauma. The real cause is unknown. Most commonly, hallux rigidus is thought to be caused by first metatarsophalangeal joint wear.

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Classification

In 1988, Hattrup and Johnson described the following radiographic classification system:

• Grade I - light change with maintained joint space and minimal spur.
• Level II - moderate changes with joint space constriction, bone proliferation in metatarsophalangeal head and phalanx and subcondral sclerosis or cysts.
• Grade III - Changes in weight with significant joint space constriction, extensive bone proliferation and sagging bodies or dorsal ossicles.

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Treatment

Non-surgical

Early treatment for mild cases of hallux rigidus may include prescription foot orthotics, shoe modifications (to take pressure from toes and/or facilitate walking), special shoes ('rocker-sole' shoes), drugs (anti-inflammatory drugs) or injection therapy (corticosteroids to reduce inflammation and pain). Physical therapy programs may be recommended, although there is very limited evidence that they provide benefits to reduce pain and improve joint function.

Surgery

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for hallux rigidus treatment. This type of operation is based on the stage of hallux rigidus.

Stage 1

Stage 1 hallux rigidus involves some loss of motion of the joint of the big toe or the first MTP joint and is often treated conservatively with prescription foot orthotics.

Stage 2

Stage 2 of the hallux rigidus involves a greater loss of motion and cartilage and can be treated through a cheilectomy in which the metatarsal head is reshaped and the bone spurs are reduced.

Stage 3

Stage 3 hallux rigidus often involves significant cartilage loss and can be treated with osteotomy in which cartilage in the first metatarsal head is repositioned, possibly combined with hemi-implant in which the proximal base of the phalanx (base of the big toe) is reappeared.

Stage 4

Stage 4 hallux rigidus, also known as the final hallux rigidus hallux involving loss of movement of large joints of the big toe and cartilage. Stage 4 hallux rigidus can be treated by joint fusion (arthrodesis) or implanted artoplasty in which both sides of the joints reappear or hinged implants are used. The combination of joints is often seen as more definitive but can cause significant changes in gait causing postural symptoms. Implants are termed "two-sided" implant implants in which the "ball" device is placed on the first metatarsal head and the "socket" portion of the base of the big toe does not have a good long-term track record. Hinged implants have been around since the 1970s, have been continuously upgraded and have the best records to improve long-term functionality.

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See also

• Hallux limitus

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References

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External links

• Hallux_rigidus_and_cheilectomy on the Duke University Health Systems Orthopedic program
• Overview at aaos.org
• Hallux Rigidus and Hallux Limitus - Classification and Treatment
• Diagram

Source of the article : Wikipedia