Surgery: Hallux Limitus/Rigidus Flashcards

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Questions and Answers

What is Hallux Rigidus?

Painful, degenerative arthritis of the first metatarsal phalangeal joint

What characterizes Hallux Rigidus?

Decreased 1st MPJ ROM; specifically dorsiflexion of the 1st MPJ

What is progressively formed in Hallux Rigidus?

Progressive osteophyte formation

What are the etiologies of hallux rigidus?

Metatarsal head shape, Metatarsus Primus Elevatus, Hallux Interphalangeus, Hallux Valgus Deformity, Trauma, Pes Planus, 1st ray hypermobility, Long/short 1st ray, Metatarsus adductus Signup and view all the answers

What is Metatarsus Primus Elevatus?

Elevation of the first metatarsal on the lateral radiograph when compared to the second metatarsal Signup and view all the answers

Greater than _________ distance of 1st met to 2nd met = MPE

5 mm Signup and view all the answers

What is the Hallux Interphalangeal Angle?

Angle formed between the bisection of the long axis of the proximal phalanx and long axis of the distal phalanx Signup and view all the answers

What is the normal value of the Hallux Interphalangeal Angle?

0-10 degrees Signup and view all the answers

Where is pain on palpation with hallux limitus?

Dorsal, medial 1st MPJ; Sub lesser metatarsal heads; Lateral aspect of the foot Signup and view all the answers

What views should be used for radiographic evaluation of hallux rigidus?

AP, oblique and lateral views of the foot weight-bearing Signup and view all the answers

What is the dorsal osteophyte sign called?

Dorsal flag sign Signup and view all the answers

What is the goal of conservative options for hallux rigidus?

Reduce pain and limit 1st MPJ motion Signup and view all the answers

What are the joint salvage surgery options?

Cheilectomy, Phalangeal dorsiflexion osteotomy, Decompression metatarsal osteotomy Signup and view all the answers

What is the indication for Keller Arthroplasty?

Elderly patients with low functional requirements needing a quick recovery and immediate weight bearing Signup and view all the answers

What is the fixation used in a 1st MPJ arthrodesis procedure?

Crossing screw fixation, Compression screw with plate and screws, K-wires Signup and view all the answers

What is the fixation and post-op course for joint salvage met osteotomy?

Types of fixation include Screw, K-wire, plate and screws. Post-operative course is procedure dependent. Signup and view all the answers

What is the post-op course for 1st MPJ arthrodesis?

NWB 4-6 weeks to allow bony fusion/consolidation Signup and view all the answers

Study Notes

Hallux Rigidus Overview

Hallux Rigidus refers to painful, degenerative arthritis of the first metatarsal phalangeal joint, leading to decreased range of motion, specifically dorsiflexion.
Characterized by progressive osteophyte formation at the joint.

Etiologies of Hallux Rigidus

Factors include metatarsal head shape, metatarsus primus elevatus, hallux interphalangeus, hallux valgus deformity, and trauma.
Additional contributors: pes planus, 1st ray hypermobility, variations in metatarsal length, and metatarsus adductus.

Metatarsus Primus Elevatus

Defined by the elevation of the first metatarsal compared to the second on lateral radiographs, indicated by more than a 5 mm difference at the distal cortices.
Results in jamming of the proximal phalanx during dorsiflexion.

Hallux Interphalangeal Angle

Angle between the longitudinal axes of the proximal and distal phalanges; normal range is 0-10 degrees.
Increased angle can contribute to stress at the 1st MPJ and exacerbate hallux limitus.

Trauma and Hallux Rigidus

Can be caused by intra-articular fractures or cumulative minor traumas.
Pain is typically unilateral and specific to the affected joint.

Pain on Palpation

Palpable pain commonly occurs on the dorsal, medial aspect of the 1st MPJ, under the lesser metatarsal heads, and laterally on the foot.

Radiographic Evaluation

Requires weight-bearing AP, oblique, and lateral views of the foot.
Key indicators include osteophytes, loose bodies, joint space narrowing, and metatarsal length and alignment.

Osteophyte Formation

Identified by the "dorsal flag sign" indicating dorsal osteophyte presence.

Regnauld Classification

Grade 1: Mild osteophytes, normal joint space.
Grade 2: Moderate osteophytes and reduced joint space with subchondral changes.
Grade 3: Severe osteophytes, significant joint space loss, degenerative changes in the hallux-sesamoid complex.

Coughlin & Shurnas Classification

Grade 1: Dorsal osteophyte with pain at maximum dorsiflexion.
Grade 2: Osteophytes present with increased pain and reduced motion.
Grade 3: Narrowed joint space, constant pain at extremes of motion.
Grade 4: Similar to grade 3, with pain throughout the range of motion.

Conservative Management Options

Use of hard-soled shoes, orthotics with Morton extension, and rocker-bottom shoes.
Medications include NSAIDs and potential steroid injections.
Goal: Pain reduction and limitation of 1st MPJ motion.

Joint Salvage Surgical Options

Procedures include cheilectomy, phalangeal dorsiflexion osteotomy, and decompression metatarsal osteotomy.

Joint Destructive Surgical Options

Options include Keller arthroplasty, Valenti arthroplasty, interpositional arthroplasty, implant arthroplasty, and 1st MPJ arthrodesis.

Cheilectomy Procedure

Involves excision of a third of the dorsal metatarsal head and surrounding osteophytes.
Indicated for Grades I and II hallux rigidus, aiming for increased dorsiflexion.

Phalangeal Osteotomy

Bonney-Kessel osteotomy repositions the hallux to decrease jamming, utilizing various fixation techniques.

Metatarsal Osteotomy Techniques

Includes Watermann, Green-Watermann, Youngswick-Austin, and Lambrinudi techniques aimed at shortening and plantarflexing the 1st metatarsal.

Implant Arthroplasty Indications and Types

Used for advanced cases, especially Grades 3 or 4; functions as a joint spacer with types including silicone, hemi, and total implants.

1st MPJ Arthrodesis

Gold standard for end-stage hallux rigidus, indicated when there is <50% cartilage remaining.
Requires careful positioning of the hallux at 10-15 degrees of dorsiflexion for optimal outcomes.
Post-operative care involves non-weight bearing for 4-6 weeks to ensure bony fusion.

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Test your knowledge on Hallux Limitus and Hallux Rigidus with these flashcards. Explore definitions, causes, and characteristics of hallux rigidus to deepen your understanding of this condition. Perfect for medical students and professionals preparing for examinations.