Introduction First metatarsophalangeal joint (MTPJ) osteoarthritis hallux rigidus (HR) is the most common arthritic condition in the foot and occurs in 2.5-7.8 % of the population over 50 years. First MTPJ arthrodesis is currently considered to be the gold standard for the treatment of end-stage HR. When treating the advanced stage of HR, arthrodesis has long been established as an effective surgical procedure providing very predictable and satisfying results. Although the surgical authors prefer joint-sparing procedures first MTPJ fusion when required is the joint destructive procedure of choice in severe HR to eliminate or minimize pain, stabilize the first MTPJ and allow the hallux to bear weight. Functional outcomes achieved with fusion are also consistent with those from other surgical procedures. The purpose of this study is to evaluate long-term functional outcomes of first MTPJ arthrodesis. Material and methods Clinical and functional outcomes of MTPJ arthrodesis performed for 19 patients (25 feet) with grade 3 or 4 HR using the Coughlin and Shurnas Classification System between September 2010 and December 2017 were reviewed. The patients' mean age was 60 years (range, 35 to 86 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 1.5 to 8 years). Ultimately, outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as good in 92 % of the cases (23/25), as fair in 8 % (2/25) with neither excellent nor poor results recorded. The median AOFAS score increased from preoperative 43.0 to postoperative 85.0 that was statistically significant (p < 0.05). Postoperative median FAAM Activities of Daily Living (ADL) was 99 %, median subjective ADL was 90 %, median FAAM sport was 84 %, and median subjective sport was 80 %. Patient subjective assessment was scored as "excellent" in 36 % of cases (9/25), "good" in 56 % (14/25), "fair" in 8 % (2/25) with no "poor" results recorded. The median VAS pain score decreased from 6 at baseline to 1 point postsurgery (p < 0.05). Conclusion First MTPJ arthrodesis was shown to be a very effective, reliable and lasting primary procedure for severe HR that provided 92% of good outcomes in our series. The procedure can be advocated as a predictable and excellent option for Coughlin and Shurnas grades 3 and 4 HR facilitating high success rates in pain relief and restoration of function.

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Introduction. Hallux rigidus (HR) is a common source of forefoot pain, which leads to progressive loss of range of motion in the first metatarsophalangeal (MTP1) joint and pathologically affects biomechanics of the whole lower limb. HR is characterized by degeneration of the articular surfaces of MTP1 joint with the formation of bone growths, cysts and erosions, osteochondral defects and loose bodies. The frequency of occurrence of HR is 1 in 40 adults older than 50 years, and this localization of osteoarthritis is the most common among all joints of the foot. The aim of this article is to improve the results of conservative treatment of HR through the use of physical rehabilitation methods, such as manual therapy, therapeutic exercises and foot orthotics.Materials and methods. This study included retrospective cases of 24 patients (28 feet), who underwent a single course of conservative treatment of HR at the European Clinic for Sports Traumatology and Orthopedics (ECSTO) of the European Medical Center (EMC) since January 2014 to December 2018. The patients’ mean age was 51 years (range, 41 to 69 years). Median time between the beginning of treatment and final examination was 26 months (interquartile range from 17 to 36 months). Patient satisfaction, VAS pain scale, AOFAS and FAAM questionnaires and MTP1 dorsiflexion were evaluated in this study.Results. According to AOFAS scale, we obtained 18% (5/28) of excellent, 78% (22/28) of good, 4% (1/28) of fair and no poor results. Median AOFAS score significantly increased from 58.5 points before treatment to 87.0 points on the final examination (p<0.05). Median FAAM daily activity subscale showed 98% of functional outcome with median subjective score of 95%, median FAAM sports score was 97% and median subjective sports score rate was 90%. Patient’s satisfaction at the final examination was “excellent” in 57% (16/28), “good” in 39% (11/28), “fair” in 4% (1/28) of cases and no poor results were obtained. Median VAS pain scale decreased from 5 points before treatment to 1 point at the final examination (p<0.05). Median angle of the MTP1 dorsiflexion significantly increased from 23° before treatment to 30° on the final examination (p<0.05).Conclusion. Described approach of the conservative treatment of HR is an effective method of treatment of early stages of the disease with high patient satisfaction rate and functional outcome.

Background The issue of rehabilitation after surgical treatment of the foot deformities is not sufficiently covered in the contemporary literature. In spite of diversity of certain approaches used in the rehabilitation process, there is no consistency in their application. In addition, there is no consensus on the effectiveness of various techniques, on the quantity and quality of the procedures and the timing of their introduction in the rehabilitation process. The objective of this article is to analyze the effectiveness of the techniques used in the rehabilitation of patients after surgical treatment of the foot deformities. Methods The article describes methods that are, in our opinion, the most effective and well-established in the post-operative recovery of patients. The  principles of complex usage of conservative treatment methods, including lymph drainage massage, manual therapy and therapeutic physical training, are covered. Results The introduction of the protocols we have developed in the rehabilitation of patients after surgical treatment of the foot deformities helped to organize the recovery process, to clarify the timing of rehabilitation measures, to improve the final result of treatment. Conclusions The use of pathogenetically justified methods of rehabilitation, which include massage, manual therapy and therapeutic physical training, promotes the most rapid and complete recovery of motor functions in patients after surgical treatment of the foot deformities.