Hallux Rigidus Surgery


Hallux rigidus surgery is a conventional treatment for a form of arthritis that affects the joint at the base of the big toe. Although most common in teens and adults who are athletic or have a history of foot trauma, the condition that this surgery treats can also manifests devoid of cause. Just like other forms of osteoarthritis, hallux rigidus, meaning stiff great toe, deals with degeneration of cartilage that manifests in a variety of ways.

Some experience a painless bony growth at the joint, painful or discomforting mobility, or a severe restriction of movement. If left untreated the pain tends to become stronger as the condition progresses and sometimes results in constant discomfort. Although, the progression is unpredictable and doesn’t always reach the point of severe restriction; there are often instances in which surgery for hallux rigidus is the only way to relieve the resulting symptoms.

This surgery can be performed in a variety of ways, depending on the stage of the condition. The following lists the details and surgical treatments for all four stages of this problem.

Stage 1: Patients often report joint pain resulting from movement or pressure put on the big toe. Generally at this stage there is no apparent physical change and x-rays are found to be devoid of abnormalities. This level of the condition usually does not yet require this type of surgery; however, treatments such as the use of a dancer’s pad or other prescription foot orthotics help to provide relief.

Stage 2: The patient often begins to feel an increase in the frequency or the duration of the pain. Visual examinations or x-rays begin to reveal a bony growth near the base of the big toe or first metatarsophalangeal (MTP) joint of the foot. Treatments at this stage can involve orthotics such as a Morton’s extension plate or hallux rigidus surgery that involves reducing bone spurs and reshaping of the metatarsal head.

Stage 3: Pain is now felt during all activities because of significant cartilage loss and the growth at the MTP joint continues to enlarge in size. At this stage x-rays will clearly show the growth as well as a narrowing of the joint space. Surgical treatment often involves an osteotomy and joint revision. Typically the cartilage at the MTP joint is repositioned and a hemi-implant is preformed in which the base of the big toe or proximal phalanx is resurfaced.

Stage 4: One now feels significant pain involving any range-of-motion and the bony growth has created an enlargement of the entire joint. Surgical treatments involve arthrodesis (joint fusion), the use of implants, or arthroplasty (resurfacing of both sides of the joint).

Although all forms of surgery are common and considered effective, most patients report that although joint fusion is the most permanent fix, it can lead to a disabled gait. Of all surgical treatments for severe cases, hinged implants and ball type joint replacement devices seem to produce the most desirable results.

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