Skip to main content

Advertisement

SpringerLink
Log in

Management of high-grade hallux rigidus: a narrative review of the literature

  • Review
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Hallux rigidus is a disease characterized by an osteoarthritic degeneration of the first metatarsophalangeal joint. Aetiology of hallux rigidus is not clear in the literature. History of trauma is considered one of the most common causes of unilateral hallux rigidus. Also, repetitive microtraumas or inflammatory and metabolic causes such as gout, rheumatoid arthritis and seronegative arthropathy can cause degeneration of the joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified main operative procedures to treat of hallux rigidus. This may provide current information for med-school students, researchers and physicians. A comprehensive literature search using PubMed database has been performed. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. High-grade hallux rigidus represents a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cotterill JM (1887) Stiffness of the great toe in adolescents. Br Med J 1:1158

    Article  CAS  Google Scholar 

  2. Hamid KS, Parekh SG (2015) Clinical presentation and management of hallux rigidus. Foot Ankle Clin 20:391–399. https://doi.org/10.1016/j.fcl.2015.04.002

    Article  PubMed  Google Scholar 

  3. Ho B, Baumhauer J (2017) Hallux rigidus. EFORT open Rev 2:13–20. https://doi.org/10.1302/2058-5241.2.160031

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hamilton WG, O’Malley MJ, Thompson FM, Kovatis PE (1997) Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int 18:68–70. https://doi.org/10.1177/107110079701800204

    Article  CAS  PubMed  Google Scholar 

  5. Gould N, Schneider W, Ashikaga T (1980) Epidemiological survey of foot problems in the continental United States: 1978–1979. Foot Ankle 1:8–10

    Article  CAS  Google Scholar 

  6. Lam A, Chan JJ, Surace MF, Vulcano E (2017) Hallux rigidus: how do I approach it? World J Orthop 8:364–371. https://doi.org/10.5312/wjo.v8.i5.364

    Article  PubMed  PubMed Central  Google Scholar 

  7. Coughlin MJ, Shurnas PS (2003) Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 24:731–743. https://doi.org/10.1177/107110070302401002

    Article  PubMed  Google Scholar 

  8. Shurnas PS (2009) Hallux rigidus: etiology, biomechanics, and nonoperative treatment. Foot Ankle Clin 14:1–8. https://doi.org/10.1016/j.fcl.2008.11.001

    Article  PubMed  Google Scholar 

  9. Shereff MJ, Bejjani FJ, Kummer FJ (1986) Kinematics of the first metatarsophalangeal joint. J Bone Joint Surg Am 68:392–398

    Article  CAS  Google Scholar 

  10. Polzer H, Polzer S, Brumann M et al (2014) Hallux rigidus: joint preserving alternatives to arthrodesis—a review of the literature. World J Orthop 5:6–13. https://doi.org/10.5312/wjo.v5.i1.6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Deland JT, Williams BR (2012) Surgical management of hallux rigidus. J Am Acad Orthop Surg 20:347–358. https://doi.org/10.5435/JAAOS-20-06-347

    Article  PubMed  Google Scholar 

  12. Hattrup SJ, Johnson KA (1988) Subjective results of hallux rigidus following treatment with cheilectomy. Clin Orthop Relat Res 226:182–191

    Google Scholar 

  13. Coughlin MJ, Shurnas PS (2003) Hallux rigidus. Grading and long-term results of operative treatment. J Bone Jt Surg - Ser A. https://doi.org/10.2106/00004623-200311000-00003

    Article  Google Scholar 

  14. Clutton HH (1894) The treatment of hallux valgus. St Thomas Rep 22:1–12

    Google Scholar 

  15. Raikin SM, Ahmad J (2008) Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint: Surgical technique. J Bone Jt Surg - Ser A. https://doi.org/10.2106/JBJS.H.00368

    Article  Google Scholar 

  16. Grady JF, Axe TM, Zager EJ, Sheldon LA (2014) A retrospective analysis of 772 patients with hallux limitus. J Am Podiatr Med Assoc. https://doi.org/10.7547/87507315-92-2-102

    Article  PubMed  Google Scholar 

  17. Chraim M, Bock P, Alrabai HM, Trnka HJ (2016) Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. Int Orthop. https://doi.org/10.1007/s00264-016-3277-1

    Article  PubMed  Google Scholar 

  18. Kelikian AS (2005) Technical considerations in hallux metatarsalphalangeal arthrodesis. Foot Ankle Clin 10(1):167–190

    Article  Google Scholar 

  19. McNeil DS, Baumhauer JF, Glazebrook MA (2013) Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int. https://doi.org/10.1177/1071100712460220

    Article  PubMed  Google Scholar 

  20. Luk PC, Johnson JE, McCormick JJ, Klein SE (2015) First metatarsophalangeal joint arthrodesis technique with interposition allograft bone block. Foot Ankle Int. https://doi.org/10.1177/1071100715577953

    Article  PubMed  Google Scholar 

  21. Donegan RJ, Blume PA (2017) Functional results and patient satisfaction of first metatarsophalangeal joint arthrodesis using dual crossed screw fixation. J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2016.10.021

    Article  PubMed  Google Scholar 

  22. Campbell B, Schimoler P, Belagaje S et al (2017) Weight-bearing recommendations after first metatarsophalangeal joint arthrodesis fixation: a biomechanical comparison. J Orthop Surg Res. https://doi.org/10.1186/s13018-017-0525-z

    Article  PubMed  PubMed Central  Google Scholar 

  23. Konkel KF, Menger AG (2006) Mid-term results of titanium hemi-great toe implants. Foot Ankle Int 27(11):922–929

    Article  Google Scholar 

  24. Mann RA, Clanton TO (1988) Hallux rigidus: treatment by cheilectomy. J Bone Jt Surg - Ser A. https://doi.org/10.2106/00004623-198870030-00012

    Article  Google Scholar 

  25. Yee G, Lau J (2008) Current concepts review: hallux rigidus. Foot Ankle Int. https://doi.org/10.3113/fai.2008.0637

    Article  PubMed  Google Scholar 

  26. O’Doherty D, Lowrie I, Magnussen P, Gregg P (2018) The management of the painful first metatarsophalangeal joint in the older patient. Arthrodesis or Keller’s arthroplasty? J Bone Joint Surg Br. https://doi.org/10.1302/0301-620x.72b5.2211767

    Article  Google Scholar 

  27. Clews CNL, Kingsford AC, Samaras DJ (2015) Autogenous capsular interpositional arthroplasty surgery for painful hallux rigidus: assessing changes in range of motion and postoperative foot health. J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2014.09.004

    Article  PubMed  Google Scholar 

  28. Delacruz EL, Johnson AR, Clair BL (2011) First metatarsophalangeal joint interpositional arthroplasty using a meniscus allograft for the treatment of advanced hallux rigidus: surgical technique and short-term results. Foot Ankle Spec. https://doi.org/10.1177/1938640011402821

    Article  PubMed  Google Scholar 

  29. Hyer CF, Lee TH, Hartman JF et al (2008) Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus. Foot Ankle Int. https://doi.org/10.3113/fai.2008.0010

    Article  PubMed  Google Scholar 

  30. McBride ID, Wyss UP, Cooke TD et al (1991) First metatarsophalangeal joint reaction forces during high-heel gait. Foot Ankle 11:282–288

    Article  CAS  Google Scholar 

  31. Johnson MD, Brage ME (2016) Total toe replacement in the united states: what is known and what is on the horizon. Foot Ankle Clin 21:249–266. https://doi.org/10.1016/j.fcl.2016.01.004

    Article  PubMed  Google Scholar 

  32. Jacob HA (2001) Forces acting in the forefoot during normal gait–an estimate. Clin Biomech (Bristol, Avon) 16:783–792

    Article  CAS  Google Scholar 

  33. Schneider T, Dabirrahmani D, Gillies RM, Appleyard RC (2013) Biomechanical comparison of metatarsal head designs in first metatarsophalangeal joint arthroplasty. Foot Ankle Int 34:881–889. https://doi.org/10.1177/1071100713483096

    Article  PubMed  Google Scholar 

  34. Cook KD (2005) Capsular interposition for the Keller bunionectomy with the use of soft-tissue anchors. J Am Podiatr Med Assoc 95:180–182

    Article  Google Scholar 

  35. Carpenter B, Smith J, Motley T, Garrett A (2010) Surgical treatment of hallux rigidus using a metatarsal head resurfacing implant: mid-term follow-up. J Foot Ankle Surg 49:321–325. https://doi.org/10.1053/j.jfas.2010.04.007

    Article  PubMed  Google Scholar 

  36. Granberry WM, Noble PC, Bishop JO, Tullos HS (1991) Use of a hinged silicone prosthesis for replacement arthroplasty of the first metatarsophalangeal joint. J Bone Joint Surg Am 73:1453–1459

    Article  CAS  Google Scholar 

  37. Verhaar J, Vermeulen A, Bulstra S, Walenkamp G (1989) Bone reaction to silicone metatarsophalangeal joint-1 hemiprosthesis. Clin Orthop Relat Res 245:228–232

    Google Scholar 

  38. Lemon RA, Engber WD, McBeath AA (1984) A complication of Silastic hemiarthroplasty in bunion surgery. Foot Ankle 4:262–266

    Article  CAS  Google Scholar 

  39. Coughlin MJ, Saltzman CL, Anderson RB (2014) Mann’s surgery of the foot and ankle. Elsevier Saunders, Amsterdam

    Google Scholar 

  40. Freed JB (1993) The increasing recognition of medullary lysis, cortical osteophytic proliferation, and fragmentation of implanted silicone polymer implants. J Foot Ankle Surg 32:171–179

    CAS  PubMed  Google Scholar 

  41. Cracchiolo A 3rd, Weltmer JBJ, Lian G et al (1992) Arthroplasty of the first metatarsophalangeal joint with a double-stem silicone implant. Results in patients who have degenerative joint disease failure of previous operations, or rheumatoid arthritis. J Bone Joint Surg Am 74:552–563

    Article  Google Scholar 

  42. Cracchiolo A 3rd, Swanson A, Swanson GD (1981) The arthritic great toe metatarsophalangeal joint: a review of flexible silicone implant arthroplasty from two medical centers. Clin Orthop Relat Res 157:64–69

    Google Scholar 

  43. Gupta S, Masud S (2017) Long term results of the Toefit-Plus replacement for first metatarsophalangeal joint arthritis. Foot (Edinburgh) 31:67–71. https://doi.org/10.1016/j.foot.2017.04.006

    Article  Google Scholar 

  44. Stone OD, Ray R, Thomson CE, Gibson JNA (2017) Long-term follow-up of arthrodesis vs total joint arthroplasty for hallux rigidus. Foot Ankle Int 38:375–380. https://doi.org/10.1177/1071100716682994

    Article  PubMed  Google Scholar 

  45. Park YH, Jung JH, Kang SH et al (2019) Implant arthroplasty versus arthrodesis for the treatment of advanced hallux rigidus: a meta-analysis of comparative studies. J Foot Ankle Surg 58:137–143. https://doi.org/10.1053/j.jfas.2018.08.045

    Article  PubMed  Google Scholar 

  46. Nuesch C, Mundermann A, Horisberger M (2017) Mid-term functional outcome of a total arthroplasty of the first metatarsophalangeal joint. Clin Biomech (Bristol, Avon) 41:9–13. https://doi.org/10.1016/j.clinbiomech.2016.11.002

    Article  Google Scholar 

  47. Wetke E, Zerahn B, Kofoed H (2012) Prospective analysis of a first MTP total joint replacement. Evaluation by bone mineral densitometry, pedobarography, and visual analogue score for pain. Foot Ankle Surg 18:136–140. https://doi.org/10.1016/j.fas.2011.07.002

    Article  PubMed  Google Scholar 

  48. Gibson JNA, Thomson CE (2005) Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int 26:680–690. https://doi.org/10.1177/107110070502600904

    Article  PubMed  Google Scholar 

  49. Perler AD, Nwosu V, Christie D, Higgins K (2013) End-stage osteoarthritis of the great toe/hallux rigidus. Clin Podiatr Med Surg 30:351–395. https://doi.org/10.1016/j.cpm.2013.04.011

    Article  PubMed  Google Scholar 

  50. Meriç G, Erduran M, Atik A et al (2015) Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus. J Foot Ankle Surg 54:173–178. https://doi.org/10.1053/j.jfas.2014.10.016

    Article  PubMed  Google Scholar 

  51. Daniels TR, Younger ASE, Penner MJ et al (2017) Midterm outcomes of polyvinyl alcohol hydrogel hemiarthroplasty of the first metatarsophalangeal joint in advanced hallux rigidus. Foot Ankle Int 38:243–247. https://doi.org/10.1177/1071100716679979

    Article  PubMed  Google Scholar 

  52. Mermerkaya MU, Adli H (2016) A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up. Clin Interv Aging 11:1805–1813. https://doi.org/10.2147/CIA.S110865

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stibolt RD, Patel HA, Lehtonen EJ et al (2018) Hemiarthroplasty versus total joint arthroplasty for hallux rigidus: a systematic review and meta-analysis. Foot Ankle Spec. https://doi.org/10.1177/1938640018791017

    Article  PubMed  Google Scholar 

  54. Fieschi S, Saffarini M, Manzi L, Fieschi A (2017) Mid-term outcomes of first metatarsophalangeal arthroplasty using the Primus FGT double-stemmed silicone implants. Foot Ankle Surg 23:142–147. https://doi.org/10.1016/j.fas.2016.11.009

    Article  PubMed  Google Scholar 

  55. Giannini S, Buda R, Ruffilli A et al (2013) Bipolar fresh osteochondral allograft for the treatment of hallux rigidus. Foot Ankle Int 34:908–911. https://doi.org/10.1177/1071100713477404

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Authors would like to thank Dr. Maria Pia Cumani from Scuola di Disegno Anatomico, IRCCS Rizzoli Orthopaedic Institute (Bologna, Italy), for artwork and figures.

Author information

Authors and Affiliations

  1. 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy

    S. Massimi, S. Caravelli, M. Fuiano, M. Mosca & S. Zaffagnini

  2. Department of Orthopaedic Surgery, Ospedale Maggiore “Pizzardi”, Bologna, Italy

    C. Pungetti

Authors
  1. S. Massimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Caravelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Fuiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Pungetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Mosca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Zaffagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Caravelli.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Massimi, S., Caravelli, S., Fuiano, M. et al. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 104, 237–243 (2020). https://doi.org/10.1007/s12306-020-00646-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-020-00646-y

Keywords

Search

Navigation