Hallux rigidus: chirurgische Behandlung
Xavier Crevoisier, Lausanne
After hallux valgus (HV), hallux rigidus (HR) is the most common disorder affecting the first metatarsophalangeal joint (MTPJ). It favors the female gender and bilateral disease is more common than the unilateral. HR is frequently classified as mild / moderate / severe. However, a more subtle classification system including both functional and radiological criteria, and providing predictability for the surgical treatment type, has been developed by Coughlin & Shurnas in 2003 and is now accepted as the best grading system.
Surgical treatment for HR includes cheilectomy, excisional arthroplasty, interposition arthroplasty, phalangeal osteotomy, metatarsal osteotomy, prosthetic replacement of the joint, and first MTPJ arthrodesis. Some of these procedures may be performed alone or in combination with another one of them.
Cheilectomy and arthrodesis are perhaps the most studied procedures, both associated with very good results. In recent years, results of partial or total prosthetic replacement of the first MTPJ have been increasingly reported, sometimes with promising results but also with several drawbacks. Finally, interposition arthroplasty still remains relatively popular.
Conceptually, aiming to propose a procedure that is able to maintain a certain mobility of the first MTPJ is well understandable. Based on the local status, on the patient’s demand, and on the surgeon’s experience some kind of recommendations exists regarding the procedure to propose. Unfortunately, today, there is almost no evidence graded higher than Level IV to establish the superiority of any of the above mentioned procedures over the others. Furthermore, the vast majority of published reports include only short term follow up.
Therefore, strictly considered, the present course can only rely on information situated below the definitive evidence. Nevertheless, the lecture will highlight the best documented knowledge, the controversies, and the potential future developments in order to provide pragmatic and reasonable guidelines for the daily surgical practice.