Introduction: The foot is a very complex structure acting as the platform for all gait patterns. At present, little is known about the exact biomechanics of the foot due to the difficulties in modeling all of the components of the foot accurately. This has made it virtually impossible to develop a complete understanding of the aetiology of many diseases of the foot including hallux rigidus. We hypothesize that sagittal plane incongruency of the rotation of the 1. st. Metatarsophalangeal Joint (MTPJ), or an increase in the tension of the intrinsic plantar flexors is responsible for the development of hallux rigidus. Materials & Methods: Ground reaction forces and kinematic data from gait analysis together with anthropometric data from MRI scans of a 24 y.o. female were used to create a Mimics model of the articulation of a normal 1st MTPJ during a gait cycle. The centre of rotation was calculated by triangulating the articular surfaces. Finite element analysis was performed on the model and on similar models with the hypothesized;. joint incongruency,. an increased tension in the Flexor Hallicus Brevis and. an increased tension in the plantar fascia. Results: The results demonstrated a significant increase in the peak stresses, contact areas and stress distributions between the incongruent models compared to the congruent models. Discussion: To the best of our knowledge this is the most accurate FE model of the 1st MTPJ calculated. Hallux Rigidus is a very common forefoot disorder, with multiple etiologies and treatments advocated. This model demonstrates that an increased tension in the plantar flexors results in a reduced ROM with increased contact stresses on the joint surface. Conclusion: While it is known Hallux Rigidus has a multi-factorial etiology, the authors feel the above study demonstrates an important inherent etiology

Introduction: Hallux Rigidus(HR) is a progressive arthritic process of the first MTP joint that causes pain, stiffness and uncomfortable enlargement of the joint, thus resulting in significant morbidity. Current treatment options include cheilectomy, resection arthroplasty, distal osteotomies (eg Moberg) or arthrodesis (Gold standard). Resurfacing of the metatarsal head, and concurrent joint release allow successful treatment of all stages of Hallux Rigidus, also offering the advantages of maintenance of metatarsal length, and movement. Method: Patients with stage II-IV hallux rigidus, who had failed conservative management, had good bone stock, no previous signs of osteomyelitis and neurovascularly intact status were offered this new procedure. All procedures were performed by the senior author, in a single centre. The HemiCap. ®. MTP prosthesis was implanted using a dorsal approach to the 1st MTPJ. The joint was decompressed and dorsal / lateral bone shaping performed to maximise movement. Pre op and post op scoring at 6 weeks, 3, 6 and 12 months were recorded using AOFAS forefoot, NPS and SF12 scores. Results: 36 First metatarsal head resurfacing procedures were performed on 32 patients. Follow up ranges from 6 weeks to 18 months. Pre op scores averages were AOFAS 22.06 (8–52), SF12 35.55 (14–61.3) and NPS 8.03 (4–10). At 12 months, these average scores had improved significantly to AOFAS 82.57 (55–95) SF12 56.01 (27.5–63.4) and pain scores 0.69 (0–4). There was significant improvement of 60 points on the AOFAS forefoot score, 20 points on the SF12 scoring system, and significant decrease in pain scores of 7.34. Discussion: Initial results of MTPJ resurfacing are encouraging. This technique provides an advantage over cheilectomy which is of limited use in late stage rigidus, and over resection arthroplasty which shortens the 1st MT and risks transfer metatarsalgia. In our practice metatarsal head resurfacing is providing a useful alternative to fusion in active patients who require movement of the MTPJ. Should patients not tolerate the procedure well, the added advantage is easy conversion to the gold standard of fusion. We continue to follow these patients and add further subjects to this study

Aim: To assess medium term results of MOJE arthroplasty for degenerative Hallux Rigidus. Materials and Methods: Patients over 18 years of age with symptomatic degenerative hallux rigidus, with at least three years follow up were included in the study. Patients who had previous surgery for hallux rigidus were excluded. A press fit Moje ceramic on ceramic prosthesis was implanted using the standard technique. Patients were non-weight bearing for the initial two weeks followed by physiotherapy according to the Moje protocol. All patients were assessed radiologically and clinically using the AOFAS (American Orthopaedic Foot and Ankle Society) and Foot Function Index (FFI – R, short form) as the primary outcome measure and a Visual Analogue Pain score (VAS) as the secondary outcome measure. Radiological assessment was carried out independently by two authors. Prosthesis loosening was defined as more than 5mm subsidence (sum of proximal and distal components), implant tilting and presence of osteolytic lesions. Revision of arthroplasty was taken as an end point to define failure. Results: 27 Moje replacements of the first metatarso-phalangeal joint in 25 patients operated by one surgeon were included in the study. There were 22 female and 3 male patients with a mean age of 61 (range: 48–83). Mean preoperative range of movement (sum of dorsi and plantar flexion) was 310 (range: 10–65). Mean preoperative FFI – R score was 100 (range: 53–183); mean preoperative AOFAS score was 45 (range: 28–64); mean preoperative VAS was 8 (range: 3–10). The average follow up was 49 months (range: 36–60). There were no wound complications. Postoperatively, 5 joints (19%) required closed manipulation and 3 joints (11%) required open arthrolysis to improve the range of movement. Three joints (11%) drifted into valgus, two of them requiring a corrective Akin osteotomy of the proximal phalanx. One patient (4%) required open reduction for dislocation and one patient required excision of the medial sesamoid for persistent pain. In all, 12 replacements (44%) were symptomatic enough to require a further procedure. None of the joints required revision. The mean postoperative range of movement was 350 (range: 15–60, p=0.85, Relative Risk=1.069, 95% Confidence Interval: 0.72–1.59). There was improvement in postoperative FFI–R score (mean: 41, Range: 27–66, p=0.007, RR=0.53, 95% CI: 0.34–0.83), AOFAS score (mean: 83, range: 68–100, p=0.07, RR: 1.5, 95% CI: 0.98–2.38) and VAS (mean: 1, range: 0–5, p=0.04, RR: 0.80, 95% CI: 0.0.66–0.97). Radiologically, there were signs of loosening of prosthesis in 4 joints (15%) without an adverse outcome in pain and functional scores. Discussion: There is a high incidence of stiffness requiring further surgical procedure to improve the range of movement following this replacement. Although pain and function scores improve with Moje arthroplasty, patients should be counselled that their range of movement may not improve and annual long-term clinical and radiological surveillance would be necessary to assess the integrity of this prosthesis. Further studies including larger number of patients with longer follow up are required to assess the long-term results of this procedure

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.

Introduction/Purpose

A randomized clinical trial of first MTP joint hemiarthroplasty with a synthetic cartilage implant demonstrated equivalent pain, function and safety outcomes to first MTP joint arthrodesis at 2 years. Recognizing that many hemiarthroplasty and total toe implants have initially good results that deteriorate over time, the purpose of this study was to prospectively assess the safety and efficacy outcomes for the synthetic cartilage implant population and to determine if the excellent outcomes were maintained at >5 years.

Introduction

Cheilectomy is a recommended procedure for the earlier stages of osteoarthritis of the 1^st metatarsophalangeal joint. Although good improvement in symptoms have been reported in many studies, the long term performance of this procedure is not well understood. It is thought that a significant number of patients go onto have arthrodesis or joint replacement. We report on a large cohort of patients who received this procedure and report on the complications and mid-term outcome.

25 First metatarso phalangeal joint replacements using the MOJE implant were prospectively assessed. There were 13 females and 10 males, with an average age of 60 years (range 45–71 years). The main indication for surgery was a symptomatic Hallux Rigidus. The minimum follow up period was 2 years (range 24–38 months). The patients were assessed before and after surgery using the AOFAS (American Orthopaedic Foot and Ankle Society Hallux Score). The mean pre operative AOFAS score was 45.60 and this improved to 85.63 after surgery. There was a significant improvement in the sub scale for pain, from 4.58 pre operatively to 31.25 post operatively. A 9.5. 0. improvement in the range of motion was noted. The authors conclude that their study demonstrates that the use of the MOJE implant for the treatment of Hallux Rigidus is a safe and useful option, although a more long term follow up is indicated

Cheilectomy is a recommended procedure for early stage osteoarthritis of the 1st metatarsophalangeal joint. Although improvement in symptoms has been reported in many studies, long term performance is not well understood. It is thought that significant numbers of patients require subsequent arthrodesis or arthroplasty. We report on a large cohort of patients receiving this procedure and on complications, and mid-term outcome.

This is a retrospective study looking at all patients undergoing cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to record outcome measures including: postoperative wound infection, patient reported improvement in pain and incidence of further surgical interventions like revision cheilectomy, conversion to arthrodesis and arthroplasty. Osteoarthritis was staged radiographically using PACS (Hattrup and Johnson classification).

A total of 240 feet in 220 patients (20 bilateral surgeries) were included with 164 females (75%) and 56 males (25%), the median age being 55 years (range 22–90 years). Radiological assessment showed 89 stage 1 arthritis (42%), 105 stage 2 (50%), 17 stage 3 (8%) and 9 patients were excluded due to unavailable radiographs. 5 patients (2%) had superficial wound infections. There were 16 further surgeries (7%); 12 arthrodesis (5%), 3 revision cheilectomy and 1 conversion to arthroplasty. 157 patients were found to be pain-free at the latest post-operative visit (77%), 48 reported minimal pain (23%), 15 patients were excluded due to incomplete data.

Cheilectomy appears to effectively reduce pain with low complication rates. Rates of conversion to arthrodesis/arthroplasty are lower than in many reported studies.

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 and aims

Hallux rigidus in the metatarsophalangeal joint (MTPJ) can be treated with arthroplasty to reduce pain and enhance motion. Few studies have investigated the functionality and the survival of HemiCap arthroplasty. Primarily we aimed to examine the medium to long-term functionality and the degree of pain after surgery. Secondarily the failure and revision rate of HemiCap implants.

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.

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.

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.

Background

Severe hallux rigidus can be treated with total or hemi arthroplasty to preserve motion in the 1st metatarsophalangeal joint (MTPJ). Decreased dorsiflexion impairs the rollover motion of the 1st MTPJ and recent studies of patients with 1st MTPJ osteoarthritis show increased plantar forces on the hallux.

Introduction: We present 34 patients diagnosed with hallux rigidus treated by percutaneous surgery. We analyzed the surgical techniques used and the functional results achieved.

Materials and methods: We retrospectively collected 34 patients (24 women). Patients were stratified by means of parametric x-rays (Hanft classification from 1 to 4). Treatment consisted in a double osteotomy, also known as Keller’s technique, using percutaneous procedures. The postoperative protocol consisted of walking, use of orthopedic footware, and early mobilization.

Results: Mean age was 68.78 years and mean follow-up was 31.45 months. Mean time from first clinical visit to surgery was 4.38 years; most patients had received conservative treatment. The mean degree of hallux rigidus according to the standard classification was 2.5. The mean value of the metacarpophalangeal joint arc and interphalangeal joint arc was 40.35°and 52.14° respectively. Return to work activities was achieved in 90.9%. The mean value according on the VAS (visual analogue scale) (0–10) was 3.14. The mean value on the AOFAS scale was 62.57 (0–100).

Conclusions: Percutaneous surgery is a satisfactory method for the treatment of hallux rigidus, enabling the patient to quickly return to work. This procedure avoids the use of osteosynthesis materials and minimizes the complications seen in open surgery.

Twenty-two patients who underwent thirty-four Kellers’ excision arthroplasty were followed up at an average of thirty-five months. They were assessed using AFAOS, satisfaction and radiological evaluation. The average hallux score was eighty- five (fifty-two to one hundred) while the average lesser toe score was ninety- two (seventy-five to one hundred). The average pain score was thirty- six (twenty to forty) for the hallux and thirty-eight for the lesser toes (twenty to forty). 23/34(68%) had good to excellent, 6/34 (18%) had fair and 5/34(14%) had poor results. The great toe was moderately short, but most patients do not seem to mind this. 91% patients were satisfied with the results.

We undertook a retrospective study of Kellers’ excision arthroplasty done over the last seven years to assess the medium term results.

Twenty-two patients who underwent thirty- four Kellers’ excision arthroplasty were followed up at an average of thirty-five months. They were followed up using the AFAOS, patient satisfaction and radiological evaluation. The average age at the time of surgery was 67.4 years. There were seventeen females (twenty-five feet) and five males (nine feet). All patients underwent bunionectomy along with excision of proximal third of the proximal phalanx. Of these twenty underwent K wire stablization of the hallux following excision.

The average hallux score was eighty- five (range sixty-two to one hundred) while the average lesser toe score was ninety- two (range seventy-five to one hundred). The average pain score was thirty- six (range twenty to forty) for the hallux and thirty-eight for the lesser toes (twenty to forty). 23/34 (68%) had good to excellent, 6/34 (18%) had fair and 5/34(14%) had poor results. The average correction of the hallux valgus was 9o. The average IMT was 25o preoperatively and 18o postoperatively. The average shortening was 7 mm. Complications included two cases of transfer metatarsalgia and two cases of clawing of the lesser toes. One patient developed abscess which settled after incision and drainage. Thirty-one out of thirty-four patients were satis-fied with the final outcome and thirty out of thirty-four patients would have the operation on the other feet.

The great toe is moderately short, but most patients do not seem to mind this. 91% patients were satisfied with the results.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has been reported as gold standard for the treatment of advanced hallux rigidus and is a well-documented procedure. However, many patients demand a mobile MTPJ and therefore joint sparing procedures like MTPJ-arthroplasty have gained popularity. The aim of the present study was to present first mid-term results after hemiarthroplasty to treat advanced osteoarthritis of the first MTPJ.

Between April 2006 and October 2013, a total of 81 hemiprostheses (AnaToemic®, Arthrex) in 71 consecutive patients (44 females, 27 male, 10 bilateral; mean age, 58 [range, 45–82]) were implanted at the St. Vincent Hospital Vienna (Austria). The indication for surgery was persistent MTPJ pain after failed conservative treatment combined with radiologic evidence of osteoarthritis (advanced hallux rigidus grade II-IV). Patients were clinically examined using the American Orthopaedic Foot and Ankle Society (AOFAS) score before surgery and at the final follow-up visit. Patient's satisfaction with the treatment was recorded. Radiological results were evaluated using standard x-rays and revision surgeries were documented.

The mean preoperative AOFAS Scores significantly increased from 51 to 88 points after an average follow-up duration of 5 years (p<0.001). Most patients (76%) were either very satisfied or satisfied with the procedure. Radiological assessment showed some kind of radiolucencies on the base plate, whereas the stem of the prosthesis was well integrated in most of the cases; however clinical outcome was not affected by minor radiolucent lines on the base plate. In the majority of patients the implant was in situ at last follow-up. If revision surgery, due postoperative pain or implant loosening, was required; it occurred within 12 to 36 months.

According to our promising mid-term results with a MTPJ-hemiprostheses, we conclude that MTPJ-arthroplasty is an effective alternative treatment modality for anatomical reconstruction of the first MTPJ with the benefit to reduce pain and maintain mobility.

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.

Purpose of the study: The efficacy of metatarsophalangeal joint (MPJ) fusion for the treatment of hallux rigidus has been well defined in the literature. There is however still some debate about the efficacy of conservative treatment, especially concerning the respective role for each of several different techniques.

Material and methods: This study reports the analysis of 113 patients treated for hallux rigidus with minimum one year follow-up. Mean age of this predominantly female population was 58 years. Fusion of the MPJ of the great toe was performed for 77% of patients and conservative treatment for 23%: isolated osteophytectomy (n=5), dorsal cheilectomy and shortening osteotomy of P1 (5 cm on average) with or without dorsal flexion for the others. The clinical outcome was assessed with the Groulier criteria.

Results: Overall outcome was satisfactory in 85% of the patients treated by MPJ fusion; MPJ pain resolved in 92%. There was however late healing or nonunion in 13% with no apparent clinical impact. Conservative treatment successfully relieved pain in 80% of patients who were able to wear ordinary shoes and had improved dorsal flexion of the MPJ.

Conclusion: The results of this study are helpful in determining the appropriate indications for surgery as a function of the clinical and radiological presentation of hallux rigidus.

Background

PROMS and PREMS are a fundamental and essential part of the NHS. Chilectomy and fusion procedures for hallux rigidus produce varied outcomes due to their subjective nature. PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to compare what PROMS/PREMS for chilectomy/fusion for hallux rigidus are at UHSM including variance across osteoarthritis grades.