Hallux rigidus is the term used to describe end-stage limited
range of motion of the great toe joint. Hallux rigidus is often referred
to as the final stage (stage 4) of
hallux
limitus. Hallux limitus is a progressive degenerative change in the
1st mpj.
Treatment of hallux rigidus
Conservative care of hallux rigidus focuses on the use of pads to
limit the range of motion of the great toe or devices to
stiffen the shoe.
Turf toe straps
are a great short term aid for symptoms of hallux limitus and hallux rigidus.
Turf toe
plates and
carbon spring plates are two examples of inserts that can be used to stiffen
the shoe. Shoe modifications are also used to decrease bending of the
forefoot. The most common modification is called an anterior rocker sole,
seen at right.
Surgical care of hallux rigidus may include a Keller bunionectomy,
great toe fusion or implant arthroplasty. A Keller bunionectomy is an old
procedure that utilizes the capsule of the great toe joint to create a new
joint. The capsule, or lining of the joint is interposed in the position
where the joint is resected. The disadvantage of the Keller bunionectomy
is that the great toe is usually much shorter and floppy post-op.
Fusion of the great toe joint is accomplished by resection of the
joint and fixation of the joint with crossed screws or a plate. A bone
graft is often used to supplement shortening created when the joint is resected.
The bone graft can be from bone bank bone or from the iliac crest (crest of the
pelvis). Fusion of the great toe joint requires a 6-8 week period of
non-weight bearing for proper healing.
Implant arthroplasty (joint replacement) involves resection of the joint and
replacement of the joint with a flexible hinge. The following images
show the steps used to perform implant arthroplasty of the great toe joint.
Image 1 shows the pre-op planning and location of the incision. Images 2
and 3 show dissection of the joint and removal of arthritic spurring surrounding
the the joint. Image 4 shows the trial implant sizers. Images 5-8
show remodeling of the joint with preparation of the implant site. Image
9-12 shoe placement of the implant and final closure. This procedure is
performed at a hospital or surgery center under general anesthesia or local
anesthesia with sedation. The procedure takes about and hour to complete.
Patients can bear full weight on the foot immediately following surgery.
For additional information regarding the onset and development of hallux rigidus, please refer to
our pages on
hallux limitus.
