Aims

The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years.

Aim. To examine the mid-term survival, clinical and patient reported outcomes of the silastic 1. st. metatarsophalangeal joint replacement for the treatment of end stage hallux rigidus. Methods. We reviewed 83 consecutive silastic arthroplasties performed in 79 patients for end stage hallux rigidus. There were 3 men and 76 women; mean age 63 years (range 45–78 years). No patient was lost to follow up. Average follow-up was 5.3 years (1.1–11.3 years). The EQ 5D–5L Health index, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analogue scale (VAS) of pain and overall satisfaction rate (Likert scale) were collected for patient reported outcomes. Results. 2 patients required revision; 1 for early infection (2 months) and 1 for stem breakage (10 years 1 month). 5 patients reported lateral metatarsalgia, 2 patients reported neuropathic pain, 6 patients developed superficial infection which fully responded to oral antibiotics, and 1 patient developed interphalangeal joint pain. 2 patients died in the cohort. Pre-operative mean MOXFQ was 44, mean EQ5D Index was 0.564 and VAS was 6.97. At mean follow-up of 5.3 years, the mean MOXFQ was 12.7 (0–57), the mean EQ5D Index was 0.851 (−0.02–1) and the mean VAS was 1.67 (0–8). The mean range of motion was 35° (30° dorsiflexion and 5° plantarflexion). The overall satisfaction rate was 90.2%. The implant survival rate was 97.6%. Conclusions. The silastic big toe arthroplasty offers excellent clinical mid term survival and functional outcomes and could be considered as an attractive alternative to traditional fusion for end stage hallux rigidus

Background. Cheilectomy and arthrodesis are accepted procedures for symptomatic hallux rigidus. Although good functional outcomes have been reported, there is little data available on post-operative sporting ability for these patients. Aims. We investigated sporting ability and functional outcomes of two cohorts of patients, the first underwent dorsal cheilectomy and the second arthrodesis. Methods. Physical and sporting ability was assessed using the Foot & Ankle Ability Measure (FAAM) sports questionnaire. Functional outcomes were assessed using MOXFQ. Radiological assessment was done according to Hattrup and Johnson classification. (HJ). Results. Group A (cheilectomy) consisted of 38 feet (35 patients) with a mean age of 57.2 (31–84) and mean follow-up 21.4 months (6–43). 21.6% were HJ1, 43.2% HJ2 and 35.1% HJ3. Group B (arthrodesis) consisted of 49 feet (47 patients) with a mean age of 64.1 (41–81) and mean follow-up 18.5 months (5–41). 6.8% were HJ1, 40.9% HJ2 and 52.3% HJ3. Mean FAAM score for group A was 78.89% (28.1%–100%). Mean FAAM score for group B was 81.55% (28.1%-100%). Mean MOXFQ score for group A was 14.89/64 (0–41). Mean MOXFQ score for group B was 10.43/64 (0–50). Pain, walking/standing and social domains were 29.74 (0–70), 21.8 (0–96.4) and 17.76 (0–68.8) in group A respectively. In group B, it was 14.79 (0–75), 16.54 (0–78.6), and 17.76 (0–100) respectively. FAAM was higher for group B in comparison to group A, but not statistically significant (P=0.425). Mean MOXFQ score was better in group B compared to group A (P< 0.05). Pain domain in particular was better in group B (P< 0.05). Conclusion. Our results suggest that both cheilectomy and arthrodesis for hallux rigidus result in similar post-operative sporting ability. Arthrodesis is superior to cheilectomy in overall functional outcomes, particularly in the pain domain

Introduction: Advanced stages of first metatarsophalangeal (MTP) arthritis have traditionally been treated with resection arthroplasty or arthrodesis. Total- and hemiarthroplasty using various prosthetic replacements of the MTP joint, or phalangeal base, have been reported with variable success. A new metatarsal resurfacing system allows for intraoperative joint geometry mapping and placement of a contoured prosthetic. Methods: Twenty-five patients with advanced stage hallux rigidus were included in this investigation and have undergone metatarsal head resurfacing (HemiCAP® Prosthesis, Arthrosurface Inc., Franklin, MA). The average age of the patients was 51 years. All patients were assessed with the Short Form 36 Health Survey (SF-36) and the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating system for the Hallux, physical examination and radiographic evaluation. The average follow up was 20 months (range: 8 to 28 months). Results: Postoperative passive dorsiflexion increased on average by 31 degrees from 34 degrees at baseline to 65 degrees at last follow-up. The mean AOFAS score improved from 44.1 to 82.1. The average SF-36 score improved from 81.2 to 96.1. The preoperative visual analogue pain score was reduced from 6.8 to 1.4 at last follow-up. No radiographic evidence of implant loosening, subsidence, or periprosthetic radiolucency has been found to date. No device failures have been encountered. All patients stated they would undergo the procedure again. One patient had a superficial wound break down which resolved with conservative care. Conclusion: Although long term follow up is still necessary, the current results are very promising providing effective pain relief and improvement in range of motion. Proper implant placement does not affect the sesamoid groove. The procedure is performed with minimal joint resection and preserves viable bone stock, therefore conversion to arthrodesis or resection arthroplasty is possible should the need for further treatment arise

Objectives. Cartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As for now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants. Study design and methods. Patients at a single centre with symptomatic hallux rigidus who underwent Cartiva SCI implant procedure were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ). Results. 66 patients (19M, 47F) (43R and 23L) were followed up for an average of 14 months (min=2, max=36). 17 patients suffered from HJ2/moderate arthritis and 49 patients with grade HJ3/severe arthritis. Post-operative mean FAAM scores showed statistically significant improvement (p< 0.0001). Patients reported a 40% increase in functionality during activities of daily living. All 3 MOXFQ Domain scores improved significantly (p< 0.02). The Index score improved by 28 points (p< 0.0001). There was no correlation between length of follow up or age and PROMs (r=0.129). No statistical difference was demonstrated between sexes. However clinically, males and older patients exhibit better outcomes. There was a 89.4% patient satisfaction with the use of Cartiva. Conclusions. Our study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Pain in particular was significantly reduced. One third of patients developed post-operative stiffness requiring a manipulation under anaesthesia. Patient selection is key. Additional imaging may be required to assess sesamoid osteoarthritis. At 3 years the implant has demonstrated to be safe and efficacious in the management of hallux rigidus. Durability and survivability of the implant will continue to be studied in this cohort

Introduction and purpose: The expression hallux rigidus is used to describe a situation characterized by pain and a decrease in range of movement of the first metatarsophalangeal joint: the head of the first metatarsal moves on a sagittal plane without a stable surface, in spite of stabilizers such as the phalanx itself and the gleno-sesamoid system. The aim of this retrospective study is to define demographic data and their association with etiological, clinical and radiological factors in patients with primary hallux rigidus. Materials and methods: We reviewed the records of one hundred and forty patients operated in our department between 1995 and 2005 for hallux rigidus. We selected 66 cases of primary hallux rigidus with complete clinical records. We excluded all secondary hallux rigidus cases from the study. Results: We carried out comparative ANOVA studies to validate the relationship between weight and degree of hallux rigidus, as well as the relationship with BMI (body mass index), the value of the hallux valgus and distal hallux angle, the value of the adductor and the intermetatarsal angle. All these data were studied for a confidence interval of 95% and 90%. No statistically significant relationship was found, which does not mean that there may not be a relationship between parameters. Moreover, a direct relation was found between gender and development of hallux rigidus (p=0.095), which is statistically significant for a confidence interval of 90%. Height is also a parameter related to hallux rigidus, the greater the height of the patient the greater the development of hallux rigidus (p=0.067) for a 90% confidence interval. A radiological parameter statistically related to hallux rigidus is the elevation of the first metatarsal (p=0.075) for a confidence interval of 90%. Conclusions:. Female sex and a greater frequency of hallux rigidus have a statistically significant relationship (p=0.095) for a 90% confidence interval. This is contrary to the opinion expressed in most of the literature published up to the present. The height of the patient and a greater frequency of hallux rigidus seem to have a statistically significant relationship for a 90% confidence interval (p=0.067). This has not been mentioned up to now in any published paper. The metatarsus primus elevatus is the only anatomical-radiological factor that we found, in our study, to have a statistically significant relationship with the appearance of hallux rigidus (p=0.075) for a 90% confidence interval. For factors such as hypermobility of the 1. st. toe, excess of the 1st axis, adductor metatarsus, interphalangeal hallux valgus and chevron shaped joint, we have found no significant relationship with the development of hallux rigidus

Introduction. Studies have compared outcomes of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on outcomes. We evaluated data from a prospective, RCT of MTPJ1 implant hemiarthroplasty (Cartiva) and arthrodesis to determine the association between patient factors and clinical outcomes. Methods. Patients ≥18 years with Coughlin hallux rigidus grade 2, 3, or 4 were treated with implant MTPJ1 hemiarthroplasty or arthrodesis. Pain VAS, Foot and Ankle Ability Measure (FAAM) Sports and ADL, and SF-36 PF scores were obtained preoperatively, and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Final outcomes, MTPJ1 active peak dorsiflexion, secondary procedures, radiographs and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. Composite primary endpoint criteria for clinical success included pain reduction ≥30%, maintenance/improvement in function, and no radiographic complications or secondary surgical intervention at 24 months. Predictor variables included: grade; gender; age; BMI; symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, ROM, and pain. Two-sided Fisher's Exact test was used (p< 0.05). Results. Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus and ROM (p0.05). Conclusion. Synthetic cartilage implant hemiarthroplasty (Cartiva) is an appropriate treatment for patients with hallux rigidus grade 2, 3 or 4 and is a reasonable choice in hallux rigidus in patients with < 20 degrees HVA, with a high degree of preoperative stiffness, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain, or duration of symptoms, in contrast to what might have been expected

Background. Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief but sacrifices ROM. Recently the Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is largely based on a single cohort with mixed outcomes. We sought to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. Methods. Retrospective review of patients undergoing Cartiva SCI or arthrodesis for treating hallux rigidus was conducted. Preoperative arthritis was radiographically graded using the Vanore classification. Patient reported outcomes (PROMs) were assessed using EuroQol 5-dimension score (EQ-5D-5L) and Manchester-Oxford Foot Questionnaire (MOXFQ). Results. Between 2017 and 2020 there were 33 cases (17 Cartiva, 16 arthrodesis, mean age 59.0±9.9 years) with a mean follow up of 2.3 years. For the first MTPJ arthrodesis cohort, the MOXFQ domain scores were: Index 3.9±5.8, Walking/Standing 5.1±7.6, Pain 3.2±5.0, and Social Interaction 2.6±4.0. EQ-5D-5L Index score was 0.828±0.270 and the EQ-VAS was 72.5±23.3. For the Cartiva cohort, the MOXFQ domain scores were: Index 7.7±6.0, Walking/Standing 8.9±7.9, Pain 7.1±5.0, and Social Interaction 6.4±5.4. EQ-5D-5L Index score was 0.631±0.234 and the EQ-VAS was 74.8±20.8. There was no statistically significant difference between any MOXFQ domain or EQ-5D-5L scores. However, a negative trend in MOXFQ domains was identified for the Cartiva group, as well as a reoperation rate of 23.5%. Conclusions. The Cartiva SCI demonstrated no advantage over arthrodesis in PROMs, despite the presumed benefit of preserved ROM. A significant reoperation rate was also observed. Surgeons should be cautious in the use of this novel implant

Introduction. Arthroplasty for treatment of end stage hallux rigidus is controversial. Arthrodesis remains the gold-standard, but this procedure is not without complications, with up to 10% non-union, 14% re-operation and 10% transfer metatarsalgia rates reported. The aim of this study was to analyse the outcome of the double-stemmed silastic implant (Wright-Medical) for end stage hallux rigidus. Method. We conducted a retrospective review of a consecutive series of 108 silastic 1. st. MTPJ implanted in our Unit (January 2005 – December 2016). Data was collected from our research databases, patient notes, PACS and PROMS. No patient was lost to follow-up. Results. Average age was 60.1 years (range 42–42 years; 104F; 4M). Results show a 98.1% survivorship at an average 5.1 years follow up (range 6 months-12 years). Average pre- and post-operative MOXFQ scores were 78.8/100 and 11.0/100 respectively and VAS scores improved from 7/10 to 1.3/10, with an average post-operative range of movement of 26.3°. Overall satisfaction rate was 90.6%. 2 patients (1.9%) required revision; 1 for early infection (2 months) and 1 for stem breakage (10 years). There were 15 complications (13.9%) in the group, 5 lateral metatarsalgia, 7 patients stiffness and ongoing pain in the index joint occurred in 2.7%. There was a 20% incidence of radiological cyst formation or demarcation, but this was neither progressive, symptomatic, nor affected clinical outcome. Conclusions. The authors believe these results are superior to results of other published implants for hallux rigidus (BioPro and Cartiva). Additionally, these results do not confirm progressive osteolysis, previously reported for this implant in other series, as being a mechanism of failure. Finally, these results suggest the double stemmed silastic 1. st. MTPJ replacement provides a reliable alternative, with at least comparable outcomes, to that of fusion, for the treatment of end stage hallux rigidus

Introduction: A long first metatarsal is a recognized contributing factor to the development of hallux rigidus. It is possible to identify a sub-group of patients with a long first metatarsal and early hallux rigidus. L.S. Barouk & P. Barouk have recently described the use of a modified Weil shortening osteotomy for the treatment of this sub-group of patients. The purpose of the study was to evaluate the early results of a modified Weil’s osteotomy of the first metatarsal in selected patients with hallux rigidus. Materials and Methods: Fifteen patients with mild to moderate OA of the first MTP joint in whom the first metatarsal was at least as long as the second underwent a shortening and plantar-displacing Weil’s osteotomy. Results: At a minimum follow-up of six months all patients’ symptoms improved dramatically and the range of motion was improved in all cases. One patient, a 19 year old professional footballer, developed a stress fracture of the second metatarsal which went on to heal and he was able to return to professional football. One patient developed transfer metatarsalgia. There were no cases of AVN and all patients were satisfied with the outcome of surgery. Discussion: There are many treatment strategies for hallux rigidus. Fusion surgery provides excellent pain relief but joint preserving surgery is preferable. Cheilectomy is reliable but has a significant failure rate. Joint replacements remain experimental. Debridement of the joint in combination with longitudinal decompression of the first MTPJ provides greater range of motion than cheilectomy alone in the subgroup of patients who have a long first metatarsal. Conclusions: These early results suggest that in selected individuals with hallux rigidus associated with a long first metatarsal, a modified Weil’s osteotomy can improve the range of motion of the first MTP joint and result in significant pain relief

Introduction Plantar foot pressure measurements using pressure distribution instruments is a standard tool for diagnostic and therapeutic interventions. Foot pressure studies have measured pressure distributions in patients with various conditions such as rheumatoid arthritis, diabetes and obesity . Pressure studies in metatarsalgia and Hallux rigidus, to our knowledge, has not been reported previously. Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia and Hallux rigidus. This data may enable us to identify areas of abnormal pressure distributions and thus plan foot-orthosis or surgical intervention. Materials and Methods This was a case control study. We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia and hallux rigidus. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA). Results The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. Comparing normal with metatarsalgia, the mean pressures through the 5th metatarsal head 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects. In patients with hallux rigidus, the mean pressures through the hallux 314 (t=−3.62, p< 0.01) and mid-foot 140 (t=-5.11, p< 0.01), were significantly higher, as compared to pressures in normal subjects. Discussion Metatarsalgia is a condition that presents with pain under the region of the 2nd to 4th metatarsal heads. Hence, the normal response of the body would be to avoid putting increased pressure through this region, thus causing increased pressures to be transmitted through other parts of the foot. The foot pressures through the hallux and midfoot were higher in patients with hallux rigidus (compared to normal). This results in pressure imbalances and thus may contribute to pain, deformity and abnormal gait. Our study, confirms this, the mean plantar foot pressures were higher under the 5th metatarsal head and the midsole as compared to normal subjects. This could be explained by the tendency to walk on the outer aspect of the sole to avoid the painful area. Thus, any foot orthosis or surgery should aim to redistribute these forces. Conclusion We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. The pressures through the Hallux and midfoot were higher in oatients with hallux rigidus. This information can be used further to plan any foot-orthosis or surgery to distribute pressures more evenly across the sole of the foot

Objective. High grade hallux rigidus is a forefoot deformity characterized by a limitation of dorsiflexion of the first toe associated with pain, and severe damage of the first metatarsophalangeal joint. Most authors recommended resection arthroplasty or arthrodesis of the first metatarsophalangeal joint. The aim of this study was to present the results of our series of 42 consecutive cases of severe hallux rigidus treated by resection of the first metatarsal head and implant of a poly D-L lactic (PDLLA) bioreabsorbable spacer to promote the interposition of fibrous tissue to preserve the range of motion of the joint. Material and methods. Forty-two feet in 27 patients affected by high grade hallux rigidus were included in the study. Surgical treatment consisted of resection of the first metatarsal head and positioning of a poly D-L lactic acid (PDLLA) bioreabsorbable implant. Post-operative care consisted in gauze bandage of the forefoot, and immediate weight-bearing with talus shoes for 3 weeks. All patients were clinically and radiographically evaluated preoperatively and checked at a mean 6 (5–7) year follow-up. Results. No intraoperative complication occurred. No sinus formation were observed. All implants resulted well tolerated by the patients. Mean AOFAS score was 42±14 preoperatively and 81±9 postoperatively. Mean preoperative metatarsophalangeal joint ROM was 27±17 degrees and mean postoperative metatarsophalangeal joint ROM was 75±8 degrees. Conclusions. First metatarsophalangeal joint arthroplasty using bioreabsorbable implant demonstrated to be an effective surgical option for treatment of high grade hallux rigidus, thank to its ability to promote fibrous tissue formation during its reabsorption

Hallux rigidus was first described by Davies-Colley and Cotterill in 1887 and varied management techniques have been described by authors since. This paper carries out an audit looking at the management of hallux rigidus in 108 patients. A retrospective study was carried out on 108 patients coded as hallux rigidus/hallux valgus over a ten year period from 1992 to 2002 (33 male and 75 female) with a follow-up range from 3 to 144 months. Thirty three toes (27 patients) were fused, 20 toes had Tel Aviv procedures (17 patients) and 61 patients were managed conservatively. Of the 33 toes fused, 18 required a second procedure in the form of wire removal, two developed transient transfer metatarsalgia, one developed IP joint pain and one had asymptomatic fibrous non-union. Of the 20 Tel Aviv procedures, one toe developed hallux valgus requiring re-operation and two toes had unrelated complications, one requiring re-operation. A single method of MTP fusion when the audit was performed revealed an interesting outcome. Hallux rigidus must be managed as an ongoing continuum, not a static state

Hallux rigidus is a common condition involving the first Metatarsophalyngeal (MTP) joint. Total joint arthroplasty is an acceptable modality of treatment. A number of different prosthesis have been used. Our study aims to evaluate the outcome of uncemented ceramic on ceramic (MOJE) prosthesis, in the treatment of painful hallux rigidus. Between March 2000 and June 2005, 38 patients (53 feet) with painful hallux rigidus were treated with uncemented ceramic on ceramic (MOJE) prosthesis. There were 30 female and 8 male patients. The hallux meta-tarsophalangeal-interphalangeal scoring scale, by the American Orthopaedic Foot and Ankle Society, was used to assess these patients, pre-operatively and at follow up. A total score of 100 is possible in a patient with no pain, full range of MTP joint movement and good alignment. The average follow up was for 34 months (range 12–68 months). Three revisions were carried out in three patients, 2 for deep infection, and 2 for persisting pain. Five patients showed radiological signs of osteolysis but had no symptoms. There was one late subluxation after 32 months. One patient developed a superficial infection, which was treated successfully. The average AOFAS score pre-operatively was 45, compared to 91 post-operatively (p< 0.05). 23 patients (36 feet) classed the outcome as excellent to good. Ten of the patients subjectively described the out come of the procedure as excellent. The preop range of movement (combined dorsiflex-ion and plantarflexion) was improved from a mean of 22 degrees to 68 degrees postoperatively. The ceramic/ceramic (MOJE) total arthroplasty gave excellent results in 77% of patients. The early outcome is encouraging. We ewcommend continued use of this prosthesis for painful hallux rigidus

The main surgical options for hallux rigidus include dorsal cheilectomy, arthroplasty and fusion. Compared to other surgical procedures dorsal cheilectomy involves relatively less bone loss, maintains joint motion and still leaves the potential for a further salvage procedure such as arthrodesis. The Manchester – Oxford Foot and Ankle Questionnaire (MOXFQ) has been endorsed by the British Foot and Ankle Society and recommended as a tool to measure surgical outcome. The aim of this study was to prospectively follow-up patients following dorsal cheilectomy for hallux rigidus using the patient-reported outcome measure, the MOXFQ. Patients were deemed suitable for dorsal cheilectomy if they had symptoms of dorsal impingement (painful restriction of terminal dorsiflexion of the hallux), with absence of pain in the mid-range of passive movement (indicative of end stage arthritis), and dorsal osteophytes on radiographs. Twenty five patients with a mean age of 62 years (range: 39 – 80 years) and comprising 17 females underwent dorsal cheilectomy for hallux rigidus. At a mean follow-up of 17 months (range 9–27 months), the mean MOXFQ score improved from 33/64 (95% CI: 27 – 38) pre-operatively to 9/64 (95% CI: 6 – 13) post-operatively. Eighty-four percent of patients had a clinically significant improvement in their walking domain, 68% in the social domain, and 59% in the pain domain of the MOXFQ. Four patients were deemed failures: three patients underwent subsequent arthrodesis for persisting pain, and one patient had no improvement in any domain of the MOXFQ. In conclusion, this study has provided further evidence of the success of dorsal cheilectomy as a reliable treatment option for hallux rigidus. It has also demonstrated the sensitivity of the patient focused reporting instrument the MOXFQ in assessing surgical outcomes in foot surgery

Objective: Our aim was the record variation in foot pressures through parts of the foot, in normal subjects and compare with foot pressure distribution in patients with conditions of the foot such as symptomatic hallux rigidus and metatarsalgia. Methodology: This was an observational study. We assessed the foot pressure distributions in 30 normal subjects, using the foot pressure pedobarograph system. The foot pressures were measured through the Hallux, 1st Metatarsal head, 2,3,4th metatarsal heads, 5 metatarsal head, midfoot and hindfoot. Foot pressure in patients with hallux rigidus and metatarsalgia were compared with the pressures in normal subjects, using statistical analysis. Results: The foot pressures were measured in Kilopascals(Kpa). Independent T test was used to compare pressures. In patients with hallux rigidus, the mean pressures through the hallux 314 (t= −3.62, p< 0.01) and midfoot 140 (t=−5.11, p< 0.01), were significantly higher, as compared to pressures in normal subjects. In patients with metatarsalgia, the mean pressures through the 5th metatarsal head 217 (t=−2.32, p< 0.05) and midfoot 94 (t=−3.17, p< 0.01), was significantly higher when compared to pressures in normal subjects. Conclusion: The foot pressures through the hallux and midfoot were higher in patients with hallux rigidus (compared to normal). Thus any foot orthosis or surgery should aim to relieve the pressure through these regions. Whereas, foot pressures through 5th metatarsal head and midfoot were higher in patients with metatarsalgia (compared to normal). This reflects the adaptation the foot develops to avoid the painful region and thus any orthosis or surgery should try to spread the foot pressures evenly across the foot

In most cases the etiology of Hallux rigidus is unknown. The purpose of this presentation is to discuss the classification of hallux rigidus, as well as the treatment options for every stage. Treatment suggestions should be individualised depending not only on the grade of the hallux rigidus, but also the patient's expectations. These include expectations regarding footwear, recreational activities and the potential of further surgeries depending upon the initial choice of treatment. Emphasis will be placed on joint preserving options, including adding a Moberg osteotomy to proximal halangs to increase perceived dorsiflexion of the great toe

Background. Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint (MTPJ) of the great toe, which can result in significant pain and stiffness. Treatment using joint replacement, either by means of hemiarthroplasty or total arthroplasty of the metatarsophalangeal joint is becoming an increasingly popular option for patients with severe disease. Aim. To evaluate mid-term functional and radiological outcomes of a widely used first generation resurfacing arthroplasty system in the treatment of hallux rigidus. Method. Prospective review of patients from 2009 onwards. All patients were operated on by the senior author using the same first generation hemiarthroplasty prosthesis (HemiCAP®, Arthrosurface, USA) and surgical technique. Radiological and clinical outcomes were assessed at 3, 6, 12 and 24 months post-operatively. Patients were assessed pre- and post-operatively on an outpatient basis for MTPJ range of motion as well as outcomes using AOFAS and visual analogue scale scores. Results. 20 prostheses in 19 patients over a two year period. Mean follow-up was 18 months (range 12–24). Mean AOFAS score improved from 38.66 pre-operatively to 74.93 at 12 months post-operatively. Mean VAS score improved from 9.95 pre-operatively to 4.05 post-operatively. There was radiological subsidence in one patient. 5 patients (26%) required revision to arthrodesis due to ongoing pain and stiffness. Conclusion. Despite significant improvements in functional scores and positive radiological outcomes in most patients, we have seen high revision rates with this first generation prosthesis due to ongoing pain and stiffness. Since this study, there has been a redesign of this implant with the addition of a dorsal flange, but the first generation prosthesis still remains in use. Following our results, we have discontinued our use of this product in favour of either the newer generation hemiarthroplasty or total arthroplasty system for patients with severe hallux rigidus

The hallux rigidus, first described by Nicoladoni in 1881 (1), is the painful and decreased motion, especially dorsiflexion at the metatarsophalangeal joint, of the great toe. The purposes of this report were to evaluate the mid-term results of the Sliding osteotomy technique(2,3,4). Thirty nine (46 feet) consecutive patients (mean age 38 years) with hallux rigidus of I and II grade were followed over a five-year period. All patients were evaluated clinically and radiographically preoperatively and post operatively. At the time of final follow-up, the mean AOFAS score was significantly improved: excellent 26 (56,5%); good 12 (26%); fair 6 (13%); poor 2 (4,5%). This clinical review suggest that this procedure as a safe, effective measure to treat in patients with hallux rigidus of I and II grade

Hallux rigidus is the second most common pathological condition of the first metatarsophalangeal joint, after hallux valgus. Manipulation of the joint and injection with steroid and local anaesthetic (MUA and Injection) is widely practiced, but the literature contains little information on the results of such treatment. We report the results of this procedure performed on thirty-seven joints, with a minimum follow-up of 1 year (mean 41.2 months). Patients with mild (Grade I) changes gained symptomatic relief for a mean of 6 months and only one third required further surgery. Two thirds of patients with moderate (Grade II) disease proceeded to open surgery. In advanced (Grade III) hallux rigidus little symptomatic relief was obtained and all patients required operative treatment. We recommend that joints are Graded before treatment and that MUA and injection be used only in early (Grades I and II) hallux rigidus