Review of Current Methods of Treatment for Hallux Rigidus
Feet are prone to injury because of their role. Your feet bear your weight every day in whatever fashion you choose: walking, running, jumping, or dancing and what types of shoes you wear. Sometimes it's the back of your foot that hurts or the top, or the toe area. One disorder, called hallux rigidis, affects the big toe. Hallux refers to your toe and rigidus refers to the stiffness. The disorder is progressive, which means it gets worse with time.
It used to be that standard treatments for hallux rigidus was surgery to remove the end part of the bone that was causing the problem, although other types of surgery have been tried, even replacements or arthroplasties. The problems with the surgeries that have been done are the lasting effects, such as deformity of the joint and pain. Another surgery, cheilectomy, has been fairly successful for hallux rigidus that hasn't progressed too far. Cheilectomy is a procedure where the surgeon removes the boney bump on the top of the joint, which presses down and causes pain.
Researchers have been trying to find other ways to relieve the problem and have been looking at various types of replacements and fusing bones together. The important issue is to try to maintain flexibility in the big toe joint, unlike some of the surgeries. Flexibility of the toe is needed for proper walking.
There are a few types of replacements available to doctors in the United States right now. They have been trying them on various patients but with mixed results. In one study, by Drs. Townley and Taranow, 95 percent of 279 patients who received one particular implant were doing well. Another study, led by Dr. Pulavarti had similar findings (88 percent) from his smaller study of 32 patients. But in another study, led by Dr. Fuhrmann, which showed good results for most patients, there were also reports of loosening implants in 9 percent of patients and significant instability in 28 percent.
Patients who have had arthrodesis, or fusion, of the bones seemed to do quite well. In one study, by Drs. Gibson and Thomson, patients in the arthrodesis group had 100 percent union of the bone (meaning it didn't open or break) compared with the replacement group, where six of 27 patients had to have surgery to repair broken or slipping hardware.
Another type of arthroplasty, called the interpositional arthroplasty has been in the works, trying to correct some of the flaws in previous models. Researchers like this approach because it can be done with younger patients and still allow for them to have function and motion of the toe. To do the surgery, the surgeon removes the boney bump at the top of the joint and removes a small part of the bone. Different materials may be used to maintain the joint space, rather than joining the bones together. So far, the results have been promising.
First Metatarsophalangeal joint arthrodesis is the fusing of bones at the base of the big toe. This is done if you've had surgery already for arthritis in the joint and the symptoms haven't improved enough. The surgeons feel that because the pain is being caused by motion, by fusing the bones together and eliminating the ability for the joint to move, the pain will no longer be there.
The authors of this article conclude that if nonsurgical treatment doesn't work for early hallux rigidus, then the next step should be cheilectomy, because of its reported success. However, there isn't much in the literature to show what treatment is best for more severe hallux rigidus. The authors recommend that the surgeons try to save the joint as much as possible, particularly for younger or more active patients.
E.O. Momoh and J.G. Anderson. Hallux Rigidus: Current Concepts in Surgical Treatment. In Current Orthopaedic Practice. April 2009. Vol. 20. No. 2. Pp. 136-139.