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Flashcards in hallux rigiditis Deck (11):
1

What is hallux rigiditis ?

  • Loss of motion of the 1st metatarsal joint in adults due to degenerative disease
  • Ostephyte formation -> dorsal impingement

2

What is it aetiology ?

  • Unknown
  • Acute trauma - repetitive microtrauma predispose to arthritic changes
  • Anatomical variations of 1st MT may play a yet unproven role in arthritic predisposition

3

Describe the classification ? What grades are there?

O-4

  • Grade 0
    •  stiffness but X-ray normal
  • Grade 1
    • Mild pain extreme motion
    • X-ray - mild Dorsal osteophytes, normal joint space
  • Grade 2
    •  moderate pain with rom increasingly more constant,
    • xray-moderate dorsal osteophytes,
  • ​Grade 3
    • significant stiffness, pain at extreme rom no pain at mid-range
    • ​xray- severe dorsal osteophytes, joint space
  • ​Grade 4
    • sig stiffness, pain thru all rom- X-ray as like 3

4

What are the tx options for grade 0?

Conservative

  • Activity modification - avoid activities that leads to excessive great toe dorsiflexion
  • NSAIDs
  • Morton extension with stiff sole plate
  • Stiff sole shoe and shoe box stretching may also be used 

A image thumb
5

What imaging is useful in hallux rigiditis?

Xrays

  • AP, Lateral, Oblique views
  • See
    • Osteophytes especially dorsal
    • joint space narrowing
    • subchondral sclerosis and cysts

6

What are the tx options for grade 1-2?

Consx- as before

Operative

  • Joint debridement and synovectomy
    • pt with acute osteochondral/ chondral defects
  • Dorsal Cheilectomy
    • ​Pain w dorsiflexion is an indicator of gd result with cheilectomy
    • CI when pain in mid range
    • remove 25-30% dorsal aspect of metatarsal head & dorsal osteophytes
    • Goal is to obtain 70-90% dorsiflexion intraoperatively
  • MOBERG PROCEDURE
    • Dorsal closing wedge osteotomy of proximal phalanx
    • runners with reduced Dorsiflexion (60o required to run)
    • ​Increases df by increasing plantar flexion arc of motion- aim for runners and failed CHEILECTOMY

7

What are the tx options for grade 3-4?

  • MTPJ arthoplasty - contraversial!
  • Popular capsular interpositional cf silicone ( gd short term but synovitis in long term )
  • MTPJ ARTHRODESIS
    •  most common using dorsal plate and compression screws- mechanical strongest
    • 700-100% fusion rates
    • 15% pts experience degeneration of IPJ post surgery

8

What position to do an arthrodesis of 1st mtpj ?

  • 15Dorsiflexion in relation to floor
  • 10-15o  valgus in relation to MT shaft
  • fusion in excessive dorsiflexion-> pain at tip of toe, over IPJ under 1st MT
  • fusion in excessive plantarflexion->increased pain at tip of toe
  • Fusion in excessive valgus-> increases risk of IPJ degeneration

9

What to do for failed Arthroplasty ?

  • implant resection, + SYNOVECTONY if isolated great toe pain
  •  implant resection , bone graft and arthrodesis if great toe pain and lesser toe metatarsalgia

10

What are the symptoms and signs of hallux rigiditis?

Symptoms

  • First ray and 1st MTPJ Pain and swelling worse with push off or forced dorsiflexion of great toe
  • Shoe irritation due to dorsal osteohytes adn compressionof dorsal cutaneous nerve may lead to parathesia
  • Pain becomes less severe as disease progresses

Signs

  • Limited Dorsiflexion
  • Pain with grind test

11

What are the indications for a keller's procedure?

  • A keller's is a resection arthroplasty 
  • For- Elderly, low demand pts with significant joint degeneration and loss of motion
  • CI is pts with pre-exisiting rigid hyperextension deformity of 1st MTPJ

Keller's technique

  • involves removal the base of the first proximal phalanx
  • risk of hyperextension- cock uop deformity of toe, weakness of psuh-off and transfer metatarsalgia