Hallux Limitus & Rigidus: A Case-Based Presentation

In the context of normal first ray function during gait, what is the most critical biomechanical event facilitated by plantarflexion of the first ray?

Which of the following represents the most biomechanically cohesive rationale for the constraint in hallux dorsiflexion observed in functional hallux limitus?

In the context of surgical management for hallux rigidus, which biomechanical principle is most directly addressed by a decompression osteotomy of the first metatarsal?

What is the most critical consideration when contemplating a Valenti procedure for hallux rigidus, given its potential impact on future surgical options?

When considering the biomechanical ramifications of a Keller resection arthroplasty for end-stage hallux rigidus, what represents the most significant long-term compensatory mechanism that contributes to the procedure's eventual failure?

In the selection of an appropriate implant for first MTPJ arthroplasty, what is the MOST critical long-term biomechanical consideration regarding the material properties of the implant relative to native cartilage?

Which of the following represents the most compelling rationale against performing a chondroplasty in isolation for hallux rigidus?

In the context of the Drago, Oloff, and Jacobs classification, what is the MOST pivotal clinical distinction between Stage 1 (Functional Limitus) and Stage 2 (Adaptation) hallux rigidus that dictates treatment strategy?

Considering the long-term biomechanical consequences, which of the following complications is MOST directly attributable to over-compression during a first MTPJ arthrodesis?

What is the primary biomechanical rationale for incorporating a reverse Morton's extension in orthotic management of functional hallux limitus?

Following a cheilectomy procedure: While it may be generally true it can increase patient symptoms if the joint is deteriorated, what is the most precise underlying biomechanical concern that contributes?

What is the most substantiated long-term risk associated with utilizing metallic hemi-implants in first MTPJ arthroplasty, particularly concerning implant longevity and the potential need for revision surgery?

What is the most critical biomechanical implication of a long first metatarsal relative to a short second metatarsal in the context of hallux rigidus etiology?

What is the most crucial factor in orthotic casting for hallux limitus?

What is the rationale for a Lapidus procedure in the treatment of hallux rigidus?

What is the MOST concerning complication specific to the Kessel & Bonney procedure regarding potential future surgical interventions?

In a patient presenting with hallux rigidus and radiographic evidence of metatarsus primus elevatus, which additional clinical finding would most strongly advocate for a plantarflexory osteotomy of the first metatarsal as opposed to simple cheilectomy?

When contemplating an arthrodiastasis procedure for a patient with hallux rigidus, what is the MOST significant theoretical advantage concerning cartilage regeneration?

What is the MOST concerning aspect of flexible silicone implants?

What is the Youngswick osteotomy?

When a patient presents with late stage hallux rigidus accompanied by severe angular deformity at the first MTPJ, what is most appropriate given the primary goals of arthrodesis?

A 71-year-old obese female presents with right foot pain. Radiographs reveal late-stage hallux rigidus. She has a history of midfoot arthritis and equinus. What initial treatment approach would address the collective pathologies?

A 66-year-old female presents with right big toe joint pain, having undergone bunion surgery two years prior. Now exhibits functional limitus and NC sag. Initial treatment includes OTC orthotics, but what is the MOST appropriate next step?

A 63-year-old female smoker presents with left big toe joint pain. Exam reveals 15° of motion with crepitus. Radiographs reveal MTPJ arthrosis and rigidity. What MOST important treatment option should be considered initially?

A 29-year-old female presents with right big toe joint pain following prior surgery and is found to have a mal-positioned implant, lytic changes, a short first metatarsal, and you suspect she was a poor candidate. After removal of the implant which approach is MOST definitive approach considering her bone stock and age?

An 80-year-old female presents with left big toe joint pain after two prior foot surgeries. Exam reveals hallux extensus and 5° of motion and second metatarsal pain. What MOST appropriate treatment option for this patient?

Which of the following statements best articulates the relationship between first ray hypermobility and the pathomechanics of hallux rigidus?

During normal gait, what is the primary biomechanical function facilitated by the sliding motion within the first MTPJ complex, subsequent to the initial rolling phase?

What is the most critical biomechanical determinant of success following a first MTPJ cheilectomy procedure?

When evaluating a patient with hallux rigidus, which physical examination finding would suggest that an isolated cheilectomy may be insufficient?

What is the primary advantage of using a cannulated screw system during first MTPJ hemiarthroplasty?

In which clinical scenario might an arthrodiastasis procedure be considered as a potentially joint-sparing option?

What is the BEST treatment option given the need for clean MTPJ?

When should the Valenti procedure be used?

What is the MOST concerning with the Keller/Valenti?

Of the metallic hemi-implant, which has dorsal elevation?

What do the base resurfacing systems do?

When do we do the Keller?

What surgical procedure can be done after the implant?

Considering the interplay between arthrodiastasis and cartilage homeostasis, what is the MOST critical cellular mechanism believed to be stimulated by intermittent joint distraction that potentiates chondrogenesis in the first MTPJ?

In cases of hallux rigidus secondary to metatarsus primus elevatus, which surgical intervention offers the MOST biomechanically sound approach to restore first ray purchase during the propulsive phase of gait, while simultaneously addressing sagittal plane malalignment?

During orthotic fabrication for functional hallux limitus, what specific biomechanical modification MOST effectively mitigates the pathological jamming of the first MTPJ during dorsiflexion, assuming a pronated foot type with forefoot supinatus?

When contemplating surgical intervention for hallux rigidus in a high-performance athlete, which joint-sparing procedure offers the MOST favorable biomechanical trade-off between preserving motion and preventing the long-term sequelae of altered gait mechanics?

In managing hallux rigidus, what represents the PRIMARY advantage of employing a distal metatarsal plantarflexion osteotomy, such as the Youngswick modification, over a simple cheilectomy in patients exhibiting metatarsus primus elevatus?

In the context of end-stage hallux rigidus management, what is the MOST significant long-term biomechanical concern associated with Keller resection arthroplasty regarding its impact on adjacent structures and overall foot function?

When considering first MTPJ implant arthroplasty for hallux rigidus, what constitutes the MOST critical factor influencing long-term implant survivorship and patient satisfaction, considering the biomechanical demands during gait?

In a patient presenting with hallux rigidus and radiographic evidence of a significantly long first metatarsal relative to the second, which surgical strategy would MOST effectively address the pathomechanical etiology while optimizing first MTPJ range of motion?

What is the MOST crucial biomechanical consideration when determining the optimal degree of plantarflexion achieved during a first MTPJ arthrodesis for end-stage hallux rigidus, aiming to restore optimal gait mechanics and minimize secondary complications?

Which statement BEST encapsulates the theoretical advantage of an arthrodiastasis procedure in early-stage hallux rigidus regarding the restoration of joint homeostasis and cartilage regeneration?

During the biomechanical assessment of a patient for hallux rigidus, what clinical finding would MOST strongly contraindicate isolated cheilectomy as a viable long-term solution?

In the context of orthotic management for hallux limitus, what is the MOST critical biomechanical rationale for incorporating a reverse Morton's extension?

Which of the following statements BEST encapsulates the primary biomechanical impact of the Lapidus procedure when utilized in the context of hallux rigidus associated with underlying structural instability?

In planning a cheilectomy for hallux rigidus, what intraoperative assessment provides the MOST reliable indication that adequate decompression has been achieved, thereby maximizing the potential for increased range of motion?

Considering the properties of synthetic cartilage implants, what represents the MOST significant long-term limitation regarding their application in first MTPJ arthroplasty for hallux rigidus?

What is the MOST critical biomechanical determinant of successful and sustained pain relief following a cheilectomy procedure for hallux rigidus?

In the context of orthotic casting for hallux limitus, what is the MOST critical manual maneuver required to optimize first ray function during the casting process?

Within the context of the Drago, Oloff, and Jacobs classification, what pathological feature distinguishes Stage 2 (Adaptation) hallux rigidus from Stage 3 (Deterioration), directly influencing surgical decision-making?

When performing a Youngswick osteotomy for hallux rigidus, what is the MOST crucial intraoperative radiographic parameter to assess in order to prevent iatrogenic over-shortening of the first metatarsal?

What is the MOST significant biomechanical disadvantage associated with the Valenti procedure in the surgical management of hallux rigidus?

In the surgical treatment of hallux rigidus, which statement BEST articulates the primary rationale for performing a decompression osteotomy of the first metatarsal?

When managing hallux rigidus with a Keller resection arthroplasty, what is the MOST critical factor to consider in order to minimize the likelihood of subsequent transfer lesion development to the lesser metatarsals?

When selecting between metallic hemi-implants for first MTPJ arthroplasty, what is the MOST pertinent biomechanical advantage of a dorsal elevation design?

Within the array of surgical options for hallux rigidus, in what specific clinical scenario would arthrodiastasis be MOST strongly considered as a potentially joint-sparing intervention?

Of the various joint destructive procedures available for end-stage hallux rigidus, what is the MOST concerning aspect regarding the Keller/Valenti?

When considering postoperative management following a cheilectomy for hallux rigidus, what rehabilitation strategy is MOST critical for optimizing long-term outcomes and functional recovery?

In the context of the first MTPJ range of motion (ROM), what is the MOST consequential biomechanical characteristic of the first 20-30° of hallux dorsiflexion during gait?

During assessment for hallux rigidus, what clinical sign primarily differentiates functional hallux limitus from structural hallux rigidus?

Considering the various treatment options for hallux rigidus, in which of the following scenarios would chondroplasty be MOST appropriately utilized?

When evaluating a patient with hallux rigidus, which long-term sequela is MOST directly associated with over-compression during first MTPJ arthrodesis?

What is the MOST crucial biomechanical justification for performing a Lapidus procedure in the context of hallux rigidus management?

Which aspect of flexible silicone implants is MOST concerning when considering long-term outcomes in first MTPJ arthroplasty?

Considering normal first ray anatomy and function during gait, what primary pathomechanical effect results from an excessively rigid plantar fascia?

What is the PRIMARY biomechanical concern when incorporating a Morton’s extension for hallux rigidus?

According to the principles governing first ray biomechanics, which statement accurately describes the role of the peroneus longus tendon in mitigating the development of hallux rigidus?

What surgical approach represents the MOST biomechanically rational choice for a 29-year-old female with hallux rigidus, lytic changes to bone and a mal-positioned implant?

In the scenario of an 80-year-old female patient, previously treated with multiple surgeries, how would one address pain with hallux extensus?

In the context of first MTPJ arthrodesis, what is the MOST critical factor in determining optimal sagittal plane positioning to ensure a plantigrade foot and avoid compensatory pathology in adjacent structures?

When performing a Youngswick osteotomy for hallux rigidus associated with metatarsus primus elevatus, what is the MOST biomechanically relevant parameter to evaluate intraoperatively via fluoroscopy to mitigate the risk of adverse sequelae?

In the management of a patient with hallux rigidus, exhibiting radiographic evidence of metatarsus primus elevatus and a clinically evident, structurally shortened first metatarsal, what surgical strategy would be MOST biomechanically sound to re-establish appropriate first ray purchase during the propulsive phase of gait?

Following a technically successful cheilectomy for hallux rigidus, a patient continues to experience pain during terminal stance. Advanced imaging reveals the presence of a previously undetected intra-articular osteochondral lesion on the plantar aspect of the first metatarsal head. What secondary pathomechanical consequence MOST directly explains the patient's persistent symptoms?

In the context of Keller resection arthroplasty as a salvage procedure for end-stage hallux rigidus, what is the MOST critical intraoperative factor that determines the long-term biomechanical stability of the first ray and minimizes proximal migration of the hallux?

In the context of first ray anatomy and function, which of the following statements most accurately describes the biomechanical consequence of an elevated metatarsus primus?

In the radiographic assessment of hallux rigidus, the presence of a 'flag sign' at the first metatarsal head suggests a primary etiology of STJ supination.

Describe the biomechanical rationale for employing a reverse Morton's extension orthotic modification in the conservative management of functional hallux limitus.

According to the Drago, Oloff, & Jacobs classification, Stage III hallux rigidus is characterized by severe flattening of the first metatarsal head, dorsal osteophytosis, asymmetric joint space narrowing, degeneration of articular cartilage, ______, subchondral cystic formation, and pain on full ROM.

Match each surgical procedure for hallux rigidus with its primary biomechanical objective:

Which of the following represents the most critical consideration in determining the suitability of a joint-salvage procedure versus a joint-destructive procedure for hallux rigidus?

The primary goal of a Lapidus procedure in the context of hallux rigidus is to directly address intra-articular pathology within the MTPJ through joint debridement and resurfacing.

Explain the biomechanical principles underlying the potential for central metatarsalgia following a Keller resection arthroplasty for hallux rigidus.

In the context of interpositional arthroplasty for hallux rigidus, a significant limitation of many implant designs is the large discrepancy in the ______ of cartilage versus the implant material, potentially leading to implant subsidence and adjacent joint degeneration.

Match the following surgical procedures used for hallux rigidus with their respective primary advantages and disadvantages:

Which of the following biomechanical factors is LEAST likely to contribute directly to the development of hallux limitus?

In a patient presenting with radiographic evidence of Stage 2 hallux rigidus according to the Drago, Oloff, and Jacobs classification, a cheilectomy alone is typically sufficient to restore near-normal first MTPJ range of motion and prevent disease progression irrespective of underlying biomechanical abnormalities.

Describe the key operative steps required to perform a Youngswick osteotomy for hallux limitus, emphasizing the importance of maintaining intrinsic stability.

Arthrodiastasis for hallux rigidus involves external fixation and distraction of the joint to promote cartilage regeneration; however, its efficacy is predicated upon the absence of significant ______ and adequate patient compliance with a prolonged fixation period.

Match each surgical procedure for hallux rigidus with the most appropriate postoperative management strategy:

Which of the following statements most accurately reflects the potential drawbacks of a first MTPJ implant arthroplasty in the treatment of advanced hallux rigidus?

A first MTPJ fusion performed in excessive dorsiflexion is unlikely to produce any significant functional limitations, as the compensatory mechanisms of the lesser metatarsals can adequately accommodate changes in weight distribution during gait.

In a revision scenario following a failed first MTPJ implant arthroplasty for hallux rigidus, articulate the key considerations that would guide your decision-making between conversion to arthrodesis versus a revision implant procedure.

A Kessel-Bonney osteotomy, indicated for hallux limitus, is a ______ osteotomy of the proximal phalanx that aims to decompress the MTPJ and improve dorsiflexion, primarily through altered joint mechanics.

Match the clinical presentation characteristics with the most likely stage of hallux rigidus according to the Drago, Oloff, and Jacobs classification.

A patient presents with a long first metatarsal relative to the second, and clinical signs of functional hallux limitus. Which of the following orthotic modifications would be MOST appropriate to address the biomechanical fault?

The presence of a dorsal bunion in conjunction with hallux limitus conclusively indicates the presence of an osseous equinus, necessitating immediate surgical intervention to prevent further joint degeneration.

A patient with stage 3 hallux rigidus who is not a candidate for fusion is scheduled for a Valenti procedure. Describe the critical steps to take to ensure post operative managment.

After a cheilectomy, drilling the subchondral bone stimulates bleeding to promote _________ ___________.

Match each case presentation to the appropriate stage of hallux rigidus according to the D,O,J classification.

A 75-year-old female presents with hallux rigidus and significant dorsiflexion stiffness with imaging revealing stage 4 changes. What surgical procedure?

A reverse Mortons extension will plantarflex the hallux.

What direction should a surgeon aim to plantarflex the first ray?

If the STJ is locked or held in neutral position while plantarflexting the first ray, then the term supination/forefoot varus is considered __________.

Indicate the correct amount of dorsiflexion required with MTPJ fusion.

A patient presents with pain and limited movement in their great toe joint, a condition diagnosed as hallux rigidus. Radiographs reveal joint space narrowing, osteophyte formation, and subchondral sclerosis. Based on the Drago, Oloff, and Jacobs classification, which stage of hallux rigidus aligns with these findings?

A first MTPJ fusion aims to relieve pain and improve function by preserving the range of motion of the first metatarsophalangeal joint, while eliminating painful bone-on-bone contact.

After performing a cheilectomy, bone drilling can improve

A hallux rigidus patient has a long first metatarsal in realtion to the second and signs of functional hallux limitus. The correct offloading in this case requires a reverse ______ extension to enhance first ray ______.

Match functional/structural

When it comes to MTPJ fusion, the positioning is ___________

Keller arthroplasty is generally recommended for high impact patients.

What is not the goal with cheilectomies for joint clean up?

Keller Arthroplasty makes revision to fusion ______ ______.

Which statement most accurately delineates the biomechanical transition within the first metatarsophalangeal joint (MTPJ) during normal dorsiflexion?

In the context of hallux rigidus etiology, 'metatarsus primus elevatus' is solely a functional biomechanical phenomenon, independent of structural osseous variations.

According to the Drago, Oloff, and Jacobs classification, Stage III hallux rigidus is characterized by severe flattening of the first metatarsal head, dorsal osteophytosis, asymmetric joint space narrowing, degeneration of articular cartilage, crepitus, subchondral cystic formation, and pain on ______ ROM.

Explain the rationale behind plantarflexing the first ray during orthotic casting for functional hallux limitus, and detail its impact on sagittal plane joint motion.

Match the following surgical procedures for hallux rigidus with their primary biomechanical rationale

The Valenti procedure is universally recognized as a joint salvage technique that consistently preserves native joint mechanics and is easily reversible to arthrodesis.

Which of the following statements most accurately reflects the rationale behind the Morton's extension modification in orthotic management of hallux limitus?

In the context of first metatarsophalangeal joint (MTPJ) arthrodesis for hallux rigidus, what specific biomechanical complications may arise from excessive dorsiflexion of the hallux, and how are these typically managed?

A Youngswick osteotomy, characterized by a decompression osteotomy and an Austin osteotomy with an extra parallel cut dorsally, is primarily indicated for long first metatarsals exhibiting mild ____.

Chondroplasty is considered a definitive standalone surgical intervention for hallux rigidus, effectively addressing its underlying biomechanical etiologies.

When evaluating a patient with hallux rigidus, which radiographic finding is most indicative of a late-stage degenerative joint process according to the Drago, Oloff, & Jacobs classification?

Describe the critical steps involved in performing an orthotic casting for a patient with functional hallux limitus, emphasizing the importance of subtalar joint (STJ) and midtarsal joint manipulation.

In cases of hallux rigidus, performing a Keller resection arthroplasty in a patient with continued external rotation could result in metatarsalgia, unless the patient is ______.

A Lapidus procedure is contraindicated in patients presenting with a structurally normal first metatarsal, irrespective of the severity of their hallux rigidus.

Which statement best characterizes the primary limitation associated with the use of first metatarsophalangeal joint (MTPJ) implant arthroplasty in the management of advanced hallux rigidus?

Detail the surgical technique and expected biomechanical outcomes of a Kessel-Bonney osteotomy for hallux rigidus, including its specific advantages and potential complications.

In the context of arthrodiastasis for hallux rigidus, the procedure aims to nourish cartilage via disuse of the subchondral plate, giving the cartilage a ______.

Reverse Morton's extension is designed to limit first ray plantarflexion.

What is the typical sequence of management for a 71-year-old obese female patient (Case #1) presenting with late-stage 3 hallux rigidus, ankle equinus, and concurrent naviculocuneiform (NC) joint arthrosis?

A 66-year-old female presents with hallux limitus after a previous bunion surgery for the right foot. What distinct clinical and radiographic findings would suggest a diagnosis of 'functional limitus' as opposed to structural rigidus in this patient?

Which surgical treatment of hallux rigidus would be the least appropriate for a long 1st metatarsal bone with mild presentation of MPE?

An 80-year-old is being seen for post-op treatment on their left foot. The patient tells you they sought a 2nd opinion but was treated elsewhere. The radiographic results show MTPJ has 5 degrees of motion w/ a hallux extensus as well as sub 2nd metatarsal pain. What treatment options are available?

For a patient with hallux rigidus caused by pronation leading to dorsiflexion of the first metatarsal, a foot orthotic would need to ___ the first metatarsal to reduce the symptoms.

Which of the following arthroplasty procedures is least suited for an active athlete?

A first MTPJ implant arthroplasty with a large discrepancy in the modulus of elasticity in comparison to cobalt chromiums biomechanical structure could cause long-term sesamoiditis due to the stress fractures the discrepancy may cause.

State three different radiographic findings that would cause a doctor to identify a patient as having hallux rigidus.

Match each stage of the Drago, Oloff, & Jacobs Classification with its corresponding treatment consideration.

In order to determine the amount of motion available at a patients 1st MTPJ you assess the range of motion. What numbers (in degrees) should the ROM be to identify normal ROM?

Functional hallux limitus shows decreased hallux dorsiflexion only when the forefoot is unloaded.

Arthrodial joints aid movement with ___.

Identify which cases in series of 5 would be most appropriate for you to use custom methods rather than over-the-counter (OTC) methods.

Match the treatment plan that coincides with what pathology is occurring.

What causes the proximal phalanx sublux plantarly?

Compression occurs at the beginning range of motion.

When a patient has a painful 1st metatarsophalangeal joint, the strategy is to ___ range of motion.

A 29-year-old presents but "isn't exactly sure" what surgery they received on their foot. They have had the surgery, have limited dorsiflexion, mal-positioned implant, lytic changes and poor patient selection. As a doctor, what issues do you know you will face when creating a treatment plan?

Match the following surgical procedures with their primary purpose in addressing hallux rigidus:

Which of the following factors in the assessment of hallux rigidus are related to etiology of the disease? (Select all that apply)

In the context of first MTPJ biomechanics, which statement most accurately describes the functional interplay between the windlass mechanism and the role of the plantar aponeurosis during the propulsive phase of gait, considering the influence of subtalar joint (STJ) pronation and its impact on first ray stability and MTPJ dorsiflexion?

In the context of hallux rigidus etiopathogenesis, the presence of metatarsus primus elevatus invariably implies a structurally fixed sagittal plane deformity, categorically precluding any functional biomechanical influence or compensatory mechanism.

In patients presenting with hallux rigidus, describe the parameters for differentiating a Youngswick osteotomy candidate from a Kessel & Bonney candidate.

The Drago, Oloff, & Jacobs Classification of Hallux Rigidus categorizes Stage 4 as ______.

Match each surgical procedure for hallux rigidus with its primary biomechanical goal:

What is the normal range of motion (ROM) for the first metatarsophalangeal joint (MTPJ)?

Hallux rigidus is characterized by an increased range of motion in the first MTP joint.

Which of the following is a characteristic radiographic finding associated with hallux rigidus?

Elevation of the first metatarsal, known as metatarsus primus __________, is a potential cause of hallux rigidus.

Match each stage of the Drago, Oloff, & Jacobs classification of hallux rigidus with its corresponding characteristic:

According to the Drago, Oloff, & Jacobs classification, which stage of hallux rigidus involves obliteration of the joint space?

Orthotics are generally considered to be more effective for structural hallux rigidus than for functional hallux limitus.

Which of the following is a common surgical treatment option for hallux rigidus?

What is the primary goal of performing a cheilectomy in the treatment of hallux rigidus?

Which of the following is a characteristic of functional hallux limitus?

A Youngswick osteotomy is primarily performed to lengthen the first metatarsal.

Which of the following best describes the purpose of arthrodiastasis in treating hallux rigidus?

A Keller resection arthroplasty involves:

A Lapidus procedure primarily addresses pathology at the metatarsophalangeal (MTP) joint.

In the context of orthotic management for hallux rigidus, what is the purpose of a reverse Morton's extension?

The term 'metatarsus primus _________' refers to the elevation of the first metatarsal bone.

Which of the following represents a joint-destructive procedure for hallux rigidus?

The primary motion at the first MTPJ is purely a rolling motion.

Which of the following is NOT a potential etiology of hallux rigidus?

According to one presentation slide, what type of implant is noted to potentially sink into the metaphyseal bone?

What is a potential complication associated with a Keller resection arthroplasty, involving pain in the lesser metatarsals?

A Lapidus procedure is commonly performed to directly address pathology within the first MTPJ.

What range of motion at the 1st MTPJ could indicate the need for joint-destructive treatment?

In orthotic casting for hallux rigidus, plantarflexing the first ray is _________ to first ray function.

Which of the following surgical procedures for hallux rigidus involves the removal of osteophytes from the metatarsal head and proximal phalanx?

A 'V' cut in the sagittal plane removing the majority of the MTPJ characterizes the Keller procedure.

Among the presented surgical treatment options for hallux rigidus, which is LEAST likely to be performed in isolation?

Which of the following surgical options for hallux rigidus is particularly indicated for adolescents?

What is the 'gold standard' surgical treatment for hallux rigidus?

A 71-year-old female presents with right foot pain. Examination reveals no ROM with forefoot loaded, 40° when unloaded, pain at the dorsal aspect on palpation and mild crepitus. Radiographs reveal 1st MTPJ arthrosis and NC arthrosis w/sag. According to the Drago, Oloff and Jacobs Classification, in which stage does this patient fall within?

A 63-year-old female presents with left big toe joint pain, smoker, and left 1st MTPJ has 15° of motion loaded and unloaded. Radiographs show 1st MTPJ Arthosis and the patient presents with Structural Rigidus. According to the Drago, Oloff and Jacobs Classification, in which stage does this patient fall within?

According to one slide, the most common complication associated with the Keller Procedure is ________ ________.

Which of the following is NOT a known cause of Subsidence (Sinking of the implant into the metaphyseal bone)?

The valenti procedure indicates low functional requirements for patients similar to the Keller procedure.

What is the main property a Synthetic Cartilage Graft helps mimic?

Which of the following is NOT considered an indication for Cheilectomy?

Normal motion during propulsion at the first MTPJ switches from rolling to ________ after the initial 20-30 degrees.

When performing orthotic casting, which joint is the user supposed to being with?

What is the benefit of Osteomed Encompass?

The integra Movement Great Toe uses a cement material.

Which type of joint is the 1st MTPJ?

Normal 1st MTPJ ROM is 45-55 degrees.

Which of the following is NOT a requirement for normal 1st MTPJ ROM?

Elevation of the first metatarsal is also known as metatarsus primus ______.

Why is the term 'hallux limitus' employed?

Functional hallux limitus presents decreased hallux dorsiflexion regardless of whether the forefoot is loaded or unloaded.

Which of the following biomechanical factors contributes to Hallux Rigidus?

List three common findings associated with Hallux Rigidus.

Which radiographic finding is characteristic of Hallux Rigidus?

In the Drago, Oloff, & Jacobs Classification, Stage 1 is known as Joint Deterioration.

According to the Drago, Oloff, & Jacobs Classification, which stage typically presents with limited dorsiflexion with weightbearing but normal ROM with non-weight-bearing?

In Stage 2: Adaptation of the Drago, Oloff, & Jacobs Classification, ______ of the first metatarsal head is observed.

According to the Drago, Oloff, & Jacobs Classification, what is the treatment for Stage 1: Functional Limitus?

A treatment goal of an orthotic for hallux rigidus is to decrease ROM of a painful 1st MTPJ to mimic fusion.

Which of the following surgical treatments is classified as a joint-destructive procedure?

Removal of osteophytes from the metatarsal head and proximal phalanx, known as a ______, can be the primary procedure in surgical treatment.

Which of the following is most useful with long 1st metatarsals and mild elevatus?

Chondroplasty is commonly performed in isolation to address Hallux Rigidus.

A 'V' cut in the sagittal plane removing the majority of the MTPJ describes what procedure?

Why do patients develop central metatarsalgia with Keller procedures?

Which of the following is the 'gold standard' for hallux rigidus surgical treatment?

Patients typically like double fusions (1st MTPJ and 1st TMTJ).

A Lapidus procedure is indicated to address which structural problem?

In orthotic casting, plantarflexing the first ray to remove supinatus/forefoot varus is ______ to first ray function.

A reverse Morton's extension aims to achieve what?

Match each Drago, Oloff, & Jacobs Classification stage with its description:

Which statement is most accurate regarding orthotics and hallux rigidus?

A first ray that is too plantarflexed can create hallux IPJ pain or arthrosis.

Which statement is consistent with a Stage 4 hallux rigidus?

In the context of hallux rigidus surgical treatment, why is positioning critical for proper function post operatively?

What is the primary goal of arthrodiastasis in treating hallux rigidus?

When performing the orthotic casting, it is important to start with the ______ joint in neutral position.

A Morton's extension aims to plantarflex the hallux.

What is a major concern regarding 1st MTPJ implant arthroplasty?

Valenti considers the V cut in the sagittal plane a joint salvage procedure.

A patient presents with mild hallux limitus and a slightly elevated 1st metatarsal. What surgical procedure might be considered?

Aside from structural considerations, what else should be considered when performing a Keller?

Which surgical treatment addresses cartilage erosions, but is rarely done in isolation?

Hallux limitus and rigidus are progressive disorders of the first ______ joints.

Explain how positioning is critical for 1st MTPJ fusion.

After reviewing X-rays, you decide with the patient to do a decompression option as opposed to a joint destructive option. All of the options fall under which surgical treatment?

Which of the following is NOT a common finding in patients with Hallux Rigidus?

A Morton's extension is used to plantarflex the hallux and decreases the range of motion (ROM) of the 1st MTPJ.

According to the Drago, Oloff, & Jacobs Classification, which stage of hallux rigidus involves obliteration of the joint space, exuberant dorsal osteophytes, and less than 10 degrees of ROM?

In the context of orthotic casting for hallux rigidus, plantarflexing the first ray to remove supinatus/forefoot varus is considered ______ to first ray function.

Match the surgical procedures with their primary characteristics:

What type of joint is the first metatarsophalangeal joint (MTPJ)?

Normal ROM of the 1st MTPJ is in the range of 85-95°.

Which motion predominantly occurs during the first 20-30° of hallux dorsiflexion?

Hallux limitus is characterized by a complete absence of motion in the first MTP joint.

Elevation of the first metatarsal (metatarsus primus elevatus) in hallux rigidus causes the proximal phalanx of the hallux to do what?

Which of the following best differentiates functional hallux limitus from structural hallux rigidus?

In structural hallux rigidus, decreased hallux dorsiflexion is only present when the forefoot is loaded.

Which of the following is considered a functional (biomechanical) etiology of hallux rigidus?

What radiographic finding indicative of hallux rigidus presents as a bony growth on the dorsal aspect of the metatarsal head?

According to the Drago, Oloff, & Jacobs Classification, Stage I hallux limitus is characterized by limited dorsiflexion with weightbearing but normal ______ with non-weight-bearing.

Match the Drago, Oloff, & Jacobs Classification stages with their descriptions:

Which of the following is a characteristic radiographic finding in Stage 2 (Adaptation) of the Drago, Oloff, & Jacobs Classification for hallux rigidus?

In stage 4 (Ankylosis) of the Drago, Oloff, & Jacobs classification, joint-salvage procedures are typically the recommended treatment.

According to the treatment algorithm suggested, which of the following procedures is typically recommended for addressing peripheral osteophytosis in hallux rigidus?

What surgical procedure involves joint clean up, and removal of osteophytes from the metatarsal head and proximal phalanx?

Which of the following statements is true regarding cheilectomy?

During orthotic casting, plantar-flexing the first ray to remove supinatus/forefoot varus is recommended.

What is the main goal of using a reverse Morton's extension in orthotic management?

What is the primary effect of a Morton’s extension on the hallux?

A Youngswick osteotomy involves an Austin osteotomy and an extra parallel cut ______.

Kessel & Bonney osteotomies are contraindicated in adolescents.

What surgical procedure involves external fixation with a mini-rail to stretch periarticular soft-tissue structure for hallux rigidus?

Why is chondroplasty rarely performed in isolation for hallux rigidus?

What is the biggest risk associated with a Valenti procedure?

A Keller procedure involves resection of the base of the ______ phalanx.

A common complication of a Keller procedure is central metatarsalgia.

Which of these is NOT a common concern with 1st MTPJ implant arthroplasty:

What is a common complication with synthetic cartilage grafts?

What is often considered the 'gold standard' for hallux rigidus surgical treatment?

Patients DO like double fusions (1st MTPJ and 1st TMTJ)

Case #1: A 71-year-old female presents for treatment of her right foot pain. 1st MTPJ has no ROM with forefoot loaded and 40 degrees when unloaded. What stage of hallux rigidus is the patient most likely in?

Case #1: A 71-year-old female presents for treatment of her right foot pain. 1st MTPJ has no ROM with forefoot loaded and 40 degrees when unloaded. What conservative treatment options could be prescribed?

Case #2: A 66-year-old female presents for treatment of her right big toe joint pain. The patients first MTPJ has no ROM with forefoot loaded/50° when unloaded. What orthotics should be prescribed?

Case #3: A 63-year-old female presents for treatment of her left big toe joint pain. The patient is a smoker with a 15-degree ROM of her left first MTPJ loaded and unloaded, and there is pain with the ROM and some crepitus. What pathology is most likely present?

Case #4: A 29-year-old female presents for treatment of her right big toe joint pain. She states that she had a prior big toe joint surgery. The patient is found to be mal-positioned with Short 1st metatarsal and complains of pain throughout the rotation and 2nd metatarsal pain. What pathology is most likely present?

What is the best course of action to take if the cartilage won't last long rubbing on metal?

A patient with Hallux Valgus will be a common situation?

What is not considered as a challenge for patients under case#4?

Which factor will determine appropriate treatment option and strategy

What is a recommended conservative treatment choice to begin with

Which of the following is NOT typically a learning objective related to hallux rigidus?

Hallux limitus is characterized by complete range of motion (ROM) at the first metatarsophalangeal joint (MTPJ).

What type of joint is the first MTPJ?

In the normal first MTPJ range of motion, the ginglymus joint facilitates a ______ joint.

During normal propulsion, first ray plantarflexion changes the motion of the first MTPJ to a rolling motion.

What is the approximate degree of normal range of motion (ROM) at the first MTPJ?

Which of the following aids is associated with the shape of the first metatarsal head?

Normal first MTPJ range of motion requires an absent intact plantar aponeurosis (Windlass).

In hallux rigidus, elevation of the first metatarsal can lead to what?

What term is sometimes used when some movement is still available in the first MTP joint, as opposed to complete rigidity?

Hallux limitus is always structural and never functional.

Which of the following is characteristic of structural hallux rigidus?

Which of the following is a common biomechanical etiology of hallux rigidus?

Metatarsus primus elevatus is best described as a ______ etiology related to Hallux Rigidus.

Hallux Rigidus can sometimes be caused iatrogenically due to a previous surgery.

Which of the following is a common clinical finding associated with hallux rigidus?

What radiographic finding provides indication of Hallux Rigidus?

According to the Drago, Oloff, & Jacobs Classification, Stage I hallux limitus exhibits severe flattening of the metatarsal head.

Which of the Drago, Oloff, & Jacobs Classification stages is characterized by obliteration of joint space?

According to the Drago, Oloff, & Jacobs Classification, a Joint- ______ procedure is indicated in a Stage 1: Functional Limitus.

What is the primary difference between stage 2 and stage 3 of the Drago, Oloff, & Jacobs Classification?

Severe flattening of the first metatarsal head is a characteristic of hallux rigidus in Stage 3: Deterioration of the Drago, Oloff, & Jacobs Classification.

In the treatment algorithm for hallux rigidus, which stage typically indicates the need for a joint-destructive procedure?

Which of the following is a goal of orthotic management for hallux rigidus?

A Morton's extension is used to plantarflex the hallux

Plantarflexing the first ray to remove supinatus/forefoot varus is ______ to first ray function.

What type of orthotic modification allows the first ray to plantarflex more?

Which of the following is a joint salvage procedure for hallux rigidus?

Which of the following is not related to Cheilectomy?

A cheilectomy increases joint movement, creating greater movement of an arthritic joint, which results in less pain.

A Youngswick osteotomy is most useful with which presentation?

A Kessel & Bonney procedure is used for what procedure?

Arthrodiastasis stretches periaritucular structures using what implant?

Chondroplasty should be done in isolation

The Valenti procedure is similar to which of the following joint destructive options?

The Keller procedure includes ______ of the base of the proximal phalanx.

A 1st MTPJ Implant Arthroplasty addresses the biomechanical pathology that caused the rigidus by utilizing what feature on the implant?

1st MTPJ Fusion is considered a temporary treatment option for hallux rigidus.

Which of the following is a potential complication of malpositioning in 1st MTPJ arthrodesis?

A Lapidus procedure realigns a structurally pathologic 1st ______.

What is the average amount of motion a normal MTP1 should have unloaded?

During an orthotic casting, why is important to plantarflex 1st ray?

Ankle equinus is a possible pathology to see in MTP1 arthrosis .

Which property does the 1st synthetic cartilage implant aim to mimic?

The best treatment is usually a [BLANK] to the 1st MTP joint

Which of the following classifications is used to categorize hallux rigidus?

In functional hallux limitus, hallux dorsiflexion is decreased regardless of whether the forefoot is loaded or unloaded.

What is the normal range of motion (ROM) in degrees for the first metatarsophalangeal joint?

Elevation of the first metatarsal, also known as metatarsus primus ______, can cause the proximal phalanx of the hallux to sublux plantarly.

Which of these surgical treatments for hallux rigidus involves removing osteophytes from the metatarsal head and proximal phalanx, potentially increasing joint movement, but may also increase pain if the joint is already deteriorated?

In the context of normal first MTPJ biomechanics during gait, which statement MOST accurately delineates the interplay between rolling and sliding motions during hallux dorsiflexion?

According to biomechanical etiologies of hallux rigidus, which of the following scenarios represents the MOST complex interaction of contributing factors, integrating both structural and functional components?

When assessing radiographic findings of hallux rigidus, what is the MOST discerning characteristic that differentiates between stages of the condition, indicating progression from adaptation to joint deterioration?

In the context of hallux rigidus development, which statement BEST describes the complex biomechanical consequences stemming primarily from excessive pronation during the propulsive phase of gait?

According to the Drago, Oloff, and Jacobs classification, which feature signifies the transition from Stage II (Adaptation) to Stage III (Deterioration) in hallux rigidus?

When contemplating surgical strategies for a high-demand athlete presenting with early-stage hallux rigidus and a congruent joint, what is the MOST critical factor in determining whether to proceed with a joint-sparing versus joint-sacrificing procedure?

In the context of surgical management for hallux rigidus, which statement underlines a core principle behind performing a decompression osteotomy?

In an intraoperative cheilectomy, which technical execution poses the greatest risk of iatrogenic destabilization of the first MTP joint, potentially exacerbating progression of hallux rigidus?

When evaluating a patient for a Youngswick osteotomy, which of the following represents the MOST critical radiographic inclusion criteria to optimize outcomes?

In the decision-making process for surgical intervention with hallux rigidus, which represents the MOST significant limitation of a Kessel & Bonney procedure?

Considering the physiological rationale of arthrodiastasis, which statement accurately describes how cartilage healing is promoted?

What is the primary biomechanical rationale behind the avoidance of chondroplasty as a standalone surgical procedure?

With respect to joint destructive procedures for hallux rigidus, which surgical intervention MOST severely compromises the biomechanical integrity of the first ray, leading to predictable sequelae?

How do synthetic cartilage grafts attempt to facilitate improved joint function?

When performing a first MTPJ fusion, what is the MOST detrimental technical error that could potentially lead to significant post-operative morbidity and functional deficits?

In the treatment of hallux rigidus, what represents the MOST significant technical challenge in a Lapidus procedure?

Considering the initial non-surgical management for the 71-year-old female patient with late-stage hallux rigidus (Case #1), which addition represents the most biomechanically sound approach in addressing her collective pathologies?

In the 66-year-old female with hallux limitus following a previous bunion surgery (Case #2), what clinical and radiographic findings most strongly support a diagnosis of functional limitus?

Given the clinical presentation of the 63-year-old smoker with 15° of motion at the first MTPJ (Case #3), what represents the critical consideration when determining appropriate treatment?

When planning the revision strategy of a 29-year-old female with a mal-positioned implant, lytic changes, and considering bone stock and age (Case #4), what represents the MOST definitive surgical approach?

Which revisional surgery is the best course of action for the elderly patient in Case #5 who presents status post surgeries presenting with a hallux extensus with a pain score?

The MTPJ joint’s main function involves transitioning from rolling to ____ as the first ray begins to plantarflex and provide adequate toe-off.

What is the main role for the sesamoids?

If pain is present at end range of the MTPJ and small dorsal exostosis begins to arise, then what degree of hallux limitus is occurring?

The following criteria encompass the treatment considerations for functional vs structural hallux limitus. Which example would best be treated using custom orthotics?

If a pronated foot causes dorsiflexion then an orthotic needs to ___ the first metatarsal?

Keller Arthroplasty is a salvage procedure of the first MTP joint, what is the biggest complication?

As a doctor, what is the reasoning why we use arthrodiastasis to clean up the MTP Joint?

Synthetic cartilage grafts attempt to mimic the modulus elasticity of actual cartilage. A common complication is ____?

What is a contraindication of a Cheilectomy?

After a Cheilectomy, drilling the subchondral bone is a must, what does the doctor hope that stimulation will promote?

There are a lot of surgical options for hallux rigidus, what is regarded as the most successful?

According to the Drago, Oloff and Jacobs classification, what symptoms would a late stages patient exude?

If a 75-year-old female presents with stage 4 findings what procedure should the Doctor consider?

The first ray and big toe move in a certain motion during a normal gait cycle. During the neutral position if the STJ is locked is the forefoot varus?

What amount of dorsiflexion is required after MTPJ fusion for proper function?

Why is it important to know whether a surgeon should choose an arthroplasty or arthrodesis?

Does a patient with functional hallux limitus have pain with ROM?

With end ROM or long periods of weight bearing a hallux rigidus patient may experience some pain. When using a Mortons extension, why is that used at that point for the hallux rigidus joint?

What issues are we most likely to face from a surgical procedure with uncertain details?

How to you correct an elevated first metatarsal?

What aspect of the Youngswick osteotomy MOST significantly mitigates the risk of iatrogenic complications directly linked to sagittal plane malalignment of the first metatarsal?

Considering the complexities of arthrodiastasis, what is the MOST critical parameter to monitor throughout the entire treatment duration in order to maximize chondrogenic potential while concurrently averting irreversible joint subluxation or avascular necrosis?

In order to precisely titrate the degree of plantarflexion achieved during a first MTPJ arthrodesis for end-stage hallux rigidus, what adjunctive assessment technique MOST effectively optimizes subsequent gait biomechanics and attenuates the potential for secondary complications arising from sagittal plane malalignment?

When considering the utilization of interpositional arthroplasty for hallux rigidus, what is the MOST accurate and complete description of a universally recognized shortcoming inherent to numerous implant designs that directly contributes to implant subsidence and subsequent adjacent joint degeneration?

A patient presents with hallux rigidus attributed to a pathologically long first metatarsal in relation to the second, showing concomitant structural pronation of the foot. From a biomechanical perspective, which surgical approach would most comprehensively address the underlying pathomechanics while concurrently optimizing first MTPJ kinetics?

In orthotic fabrication for functional hallux limitus, what biomechanical rationale underlies the strategic implementation of a reverse Morton's extension, assuming a hypermobile first ray complicated by a flexible forefoot valgus?