Review
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World J Orthop. Jan 18, 2014; 5(1): 6-13
Published online Jan 18, 2014. doi: 10.5312/wjo.v5.i1.6
Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature
Hans Polzer, Sigmund Polzer, Mareen Brumann, Wolf Mutschler, Markus Regauer
Hans Polzer, Mareen Brumann, Wolf Mutschler, Markus Regauer, Munich University Hospital, Foot and Ankle Surgery, Department of Trauma Surgery-Campus Innenstadt, 80336 Munich, Germany
Sigmund Polzer, Department of Hand, Ellbow and Footsurgery, ATOS Clinic Heidelberg, 69115 Heidelberg, Germany
Author contributions: Polzer H and Polzer S concepted designed and drafted the manuscript; Brumann M and Regauer M acquired and analysed the literature and finalized the manuscript; Mutschler W gave substantial input concerning the conception and design and critically revised the manuscript; all authors gave final approval of the article to be published.
Correspondence to: Hans Polzer, MD, Munich University Hospital, Ludwig-Maximilians-University, Foot and Ankle Surgery, Department of Trauma Surgery-Campus Innenstadt, Nussbaumstrasse 20, 80336 Munich, Germany. hans.polzer@med.uni-muenchen.de
Telephone: +49-89-51602511 Fax: +49-89-51602662
Received: October 2, 2013
Revised: November 3, 2013
Accepted: November 15, 2013
Published online: January 18, 2014
Abstract

Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.

Keywords: Hallux rigidus, Osteoarthritis, First metatarsophalangeal joint, Joint preserving, Operative treatment, Osteotomy

Core tip: If nonoperative treatment fails to relieve the symptoms of hallux rigidus surgery is indicated. The procedure with the most evidence for success is the arthrodesis of the first metatarsophalangeal joint. Nevertheless, many patients prefer treatment options which preserve the joint motion. The evidence for different arthroplastic procedures is of low quality. Furthermore, in case the procedure fails to relieve the symptoms to perform an arthrodesis after resection of the joint is much more difficult and may require bone graft. Consequently, joint and motion preserving osteotomies are of great interest for treatment of hallux rigidus. We here provide a review of the different joint and motion preserving alternatives for treating hallux rigidus and the studies available investigating these procedures.