Hallux rigidus: current concepts in surgical treatment

Range of Flexion Improvement in Degenerative Stages of the First Metatarsophalangeal Joint (Hallux rigidus) with Cross-Linked Hyaluronic Acid: A Cadaveric Study

BACKGROUND

Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid.

METHODS

Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen's metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw.

RESULTS

The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37-51.5) to 58° (range, 49-69.5) degrees of loaded dorsiflexion (p > 0.006); (2) 41° (range, 40-51.5) to 58° (range, 52.5-66.5) degrees of unloaded dorsiflexion (p > 0.009); and (3) 14° (range, 10.5-24.25) to 16° (range, 14.25-28.5) degrees of unloaded plantarflexion (p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections.

CONCLUSIONS

The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures.

[Proposed global treatment algorithm for hallux rigidus according to evidence-based medicine]

INTRODUCTION

Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment.

OBJECTIVE

To present a comprehensive algorithm for treatment of all grades of this disease.

METHODS

Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence.

RESULTS

A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria.

CONCLUSIONS

The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus.