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Hallux Rigidus: A Comprehensive Review

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Foot and Ankle Disorders

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Abstract

Hallux rigidus is a condition characterized by pain and restriction in motion of the first metatarsophalangeal joint (MTPJ), especially in dorsiflexion. Although various causes have been proposed for hallux rigidus, its exact etiology has yet to be elucidated. Both dynamic and structural factors of the MTPJ itself and the surrounding tissues have been involved, in spite of trauma or osteochondritis dissecans that themselves may damage the articular surfaces of the MTPJ.

Physical examination reveals a painful swollen MTP joint with restriction of dorsiflexion. The patient usually reports a history of pain and stiffness that worsens with activities involving an MTPJ dorsiflexion, such as stairs or running.

Conservative care is the first indication for patients with hallux rigidus, depending on the extent of arthritis and symptoms. The measures commonly used include foot orthoses, modification in shoe-wear, limitations in activity, physical therapy, and injections with corticosteroid or sodium hyaluronate.

Surgical correction of hallux rigidus is indicated when conservative treatment fails to relieve pain. At the most basic level, the surgical options involve either preservation or destruction of the articular surfaces. At moderate stages, joint-preserving procedures constitute a more rational approach. Newer techniques in constant development have focused on procedures that maintain range of motion and allow patients to weight-bear immediately following surgery.

Arthroplasty has been proposed as an alternative surgical option. The main advantage of arthroplasty over arthrodesis is the preservation of movement without the risk of malunion or nonunion. Still, first MTPJ fusion represents today the mainstay of surgical care for high-grade, advanced hallux rigidus. Improvement of pain is achieved by eliminating residual degenerated cartilage layers.

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  1. Instituto de Ortopedia y Traumatología Dr. Jaime Slullitel, Rosario, Santa Fe, Argentina

    Gaston Slullitel & Valeria Lopez

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  1. Gaston Slullitel
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  1. Orthopedic Surgery Department, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, RM - Santiago, Chile

    Emilio Wagner Hitschfeld

  2. Orthopedic Surgery Department, Clínica Alemana de Santiago - Universidad del Desarrollo, Hospital Militar de Santiago – Universidad de los Andes, Santiago, RM - Santiago, Chile

    Pablo Wagner Hitschfeld

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Slullitel, G., Lopez, V. (2022). Hallux Rigidus: A Comprehensive Review. In: Wagner Hitschfeld, E., Wagner Hitschfeld, P. (eds) Foot and Ankle Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-95738-4_18

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