Whatʼs New in Surgical Options for Hallux Rigidus?

Abstract

The term hallux rigidus is used to describe a condition characterized by pain and a reduction in the range of motion, especially dorsiflexion, at the first metatarsophalangeal joint1-3. According to the etiology, hallux rigidus can be classified as primary (hallux limitus) or secondary (Table I)1,2,4-8. View this table: TABLE I Etiology of Secondary Hallux Rigidus ### Functional Consequences With normal locomotion, the amount of hallux dorsiflexion during propulsion must approximate 65° to 75°9. With hallux rigidus, dorsiflexion of the first metatarsophalangeal joint is restricted9. As a consequence, during the propulsive phase of gait, functional limitation and pain lead to an internal rotation of the forefoot, reducing push-off and creating transfer metatarsalgia (Fig. 1)9,10. Fig. 1 During the propulsive phase of gait, the hallux is unable to dorsiflex adequately. As a consequence, the foot internally rotates, reducing push-off and causing transfer metatarsalgia of the lesser metatarsals. ### Indications for Surgery The indication for surgery is pain combined with degenerative changes of the first metatarsophalangeal joint. Because there is no correlation between reduction of dorsiflexion and radiographic findings in hallux rigidus, we believe that the most useful parameter for the choice of a specific surgical technique is the extent of arthritis of the metatarsophalangeal joint as seen radiographically with use of a classification system described by Coughlin and Shurnas11 and modified by us (Table II) (Fig. 2). View this table: TABLE II Classification of Arthritis of the Metatarsophalangeal Joint Associated with Hallux Rigidus Fig. 2 Radiographic classification of hallux rigidus. (See Table II for a description of the grades.) ### Patient Factors The surgical strategy has to be planned according to the arthritis classification and must include consideration of other patient factors (Table III). The goal of surgery is to relieve pain, improve function, reduce the progression of arthritis, and correct any …