What's new in surgical options for hallux rigidus?

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 This stepwise approach to the surgical treatment of hallux rigidus enabled us to achieve satisfactory results while maintaining the mobility of the first metatarsophalangeal joint and achieving considerable pain relief in most of the eighty-six patients at a mean duration of follow-up of four years. Plantar release as an isolated procedure appears to be an adequate technique to treat hallux rigidus associated with grade-0 arthritis of the metatarsophalangeal joint; in fact, at four years postoperatively, the clinical results remained satisfactory even though two patients required an arthrodesis of the first metatarsophalangeal joint because of rapid and severe progression of the arthritis Osteotomies of the distal aspect of the first metatarsal can produce an adequate decompression of the joint with relief of pain in patients with grade-1 arthritis , and cheilectomy provides optimal clinical results in hallux rigidus associated with grade-2 arthritis In some patients in all groups, progression of the arthritis was observed. We believe that this occurred as a result of incorrect grading of the arthritis leading to an inadequate surgical approach or to insufficient removal of bone. When arthrodesis was indicated and the patient accepted the treatment, satisfactory results were achieved. An alternative for elderly patients, or when arthrodesis is not accepted by the patient, may be the reabsorbable implant. The spacer resorbs slowly over six months, facilitating the formation of a fibrous union that can maintain the stability and length of the toe In conclusion, hallux rigidus is a complex disorder characterized by several clinical and pathological findings. For this reason, to achieve optimal results, surgical treatment should be individualized with use of different surgical techniques depending upon the degree of arthritis and other clinical considerations