Hallux Rigidus: Demographics, Etiology, and Radiographic Assessment

Coughlin, Michael J.; Jones, Caroll P.

doi:10.1177/107110070302401002

Cited by 439 publications

(236 citation statements)

References 55 publications

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“…En principio la presencia de mayor longitud del primer metatarsiano como desarrollo de HR fue descartada por varios autores 6 , aunque Calvo y colaboradores describieron una posible relación etiopatogénica entre HR y un ín-dex plus 7 .Se ha sospechado que su origen procede de una afectación en la adolescencia, por una deformidad primaria, y en el adulto por una artritis degenerativa secundaria, pero no se han encontrado evidencias que confirmen una diferencia basada en la edad aunque es cierto que las mujeres presentan mayor incidencia 8 .…”

Section: Introductionunclassified

“…Pueden existir casos de presentación unilateral, sobre todo cuando se correlaciona con un traumatismo previo, pero la mayoría de los pacientes tienen una afectación bilateral 6 . Coughlin y Shurnas indican que cuando se revisa a los pacientes con hallux rígidus durante un periodo de tiempo prolongado, más del 80% desarrollan una sintomatología bilateral, y además cerca del 95% de los casos tienen una historia familiar de patología en hallux 6 .…”

Section: Introductionunclassified

“…Coughlin y Shurnas indican que cuando se revisa a los pacientes con hallux rígidus durante un periodo de tiempo prolongado, más del 80% desarrollan una sintomatología bilateral, y además cerca del 95% de los casos tienen una historia familiar de patología en hallux 6 .…”

Section: Introductionunclassified

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Meta-analysis of First Metatarsophalangeal Joint Implant Arthroplasty

Cook

Rosenblum

et al. 2009

The Journal of Foot and Ankle Surgery

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Resumen. El Hallux Rígidus (HR) afecta a la primera articulación metatarsofalángica (AMTF) entre el 35% y el 60% de la población mayor de 65 años y existen múltiples vías de tratamiento. En función del estadio radiológico en el que se encuentre la deformidad, se determina el procedimiento a realizar; en los estadios iniciales se realiza las técnicas de queilectomia y osteotomías correctoras mientras que en las clasificaciones más avanzadas, el cirujano escoge entre las técnicas consideradas destructivas como la artrodesis y la artroplastia. Este trabajo de fin de grado tiene como objetivo centrarse en las técnicas destructivas en 1 AMTF, para aclarar cuál de los procedimientos genera mejores resultados según una serie de parámetros; los resultados de la escala American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal scale (AOFAS), rango de movimiento (ROM) de la 1ºAMTF, clasificación radiológica. En cuanto a la técnica de artroplastias por implante, este artículo nos ofrece información sobre el material y diseño qué genera mejores resultados relacionándolo con las características del paciente como la edad, la presencia de patologías inflamatorias articulares, la viabilidad y la durabilidad del implante. La conclusión obtenida en esta revisión es que los valores obtenidos en la artrodesis según AOFAS disminuyen debido a la pérdida de movilidad, pero ambas técnicas presentan valores similares de efectividad y concluye con la decisión de que la técnica a utilizar se determina teniendo en cuenta varios factores y características del paciente. Palabras clave: Hallux rígidus; Hallux rígidus y tratamientos quirúrgicos; Hallux rígidus y Artrodesis; Hallux rígidus y Artroplastia; Hallux rígidus (Artroplastia y Artrodesis).[en] Hallux rigidus: Arthroplasty or arthrodesis. What technique produces better results?Abstract. Hallux rígidus (HR) affects the first metatarsophalangeal joint (MTPJ) between 35% and 60% of the population over 65 years and there are multiple ways of treatment. Depending on the radiological stage where you find the deformity determines the procedure to be performed; in the early stages cheilectomy techniques and corrective osteotomy is performed while the more advanced ratings, the surgeon chooses destructive techniques considered as arthrodesis and arthroplasty. This final of degree project aims to focus on 1 MTPJ destructive techniques to clarify which of the procedures generates better results by a number of parameters; outcomes of the American Orthopaedic Foot scale and Ankle Society Hallux metatarsophalangeal Interphalangeal-scale (AOFAS), range of motion (ROM) of the 1ºAMTF, radiological classification. As for the implant arthroplasty technique, this article offers information on material and design that generates better relating to patient characteristics such as age, inflammatory joint diseases, viability and durability of the implant results. The conclusion from this review is that the values obtained in the arthrodesis according AOFAS decrease due to loss of mob...

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Section: Introductionunclassified

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Meta-analysis of First Metatarsophalangeal Joint Implant Arthroplasty

Cook

Rosenblum

et al. 2009

The Journal of Foot and Ankle Surgery

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“…Symptoms are generally exacerbated with activity and alleviated by rest. [7][8][9][10][11][12][13] Few studies have assessed foot function in people displaying restricted first MPJ motion. Bryant et al 14 evaluated dynamic plantar pressures in 30 participants with symptomatic hallux limitus and 30 controls, finding that those with hallux limitus displayed significantly higher mean pressures under the hallux, lesser toes, and the third and fourth metatarsal heads.…”

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confidence: 99%

“…6 Depending on the severity of joint degeneration, OA of the first MPJ is termed hallux limitus or hallux rigidus. [7][8][9][10][11][12][13] Hallux limitus is defined as a condition in which there is restricted sagittal plane motion, whereas hallux rigidus refers to a complete absence of sagittal plane motion and subsequent joint fusion. Patients with hallux limitus/rigidus typically present with first MPJ pain, stiffness, and swelling.…”

mentioning

confidence: 99%

Plantar pressure distribution in older people with osteoarthritis of the first metatarsophalangeal joint (hallux limitus/rigidus)

Zammit

Menz

Munteanu

et al. 2008

Journal Orthopaedic Research

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The purpose of this study was to evaluate differences in dynamic plantar pressure distribution between older people with and without radiographically confirmed osteoarthritis (OA) of the first metatarsophalangeal joint (first MPJ) of the foot. Dynamic plantar pressure recordings using the TekScan MatScan 1 system were obtained during barefoot level walking in 40 older participants; 20 with radiographically confirmed OA of the first MPJ displaying less than 55 degrees of passive dorsiflexion, and 20 with no evidence of OA in the first MPJ displaying greater than 55 degrees of passive dorsiflexion. Group comparisons between the variables maximum force and peak pressure were made for seven different regions underneath the right foot (heel, midfoot, first MPJ, second MPJ, third to fifth MPJs, hallux, and lesser toes). Compared to the control group, participants with OA of the first MPJ exhibited 34% greater maximum force (7.9 AE 2.5 vs. 5.9 AE 1.7 kg, p ¼ 0.005) and 23% higher peak pressure (1.6 AE 0.3 vs. 1.3 AE 0.3 kg/cm 2 , p ¼ 0.001) under the hallux. Similar results were also found under the lesser toes with 43% greater maximum force (5.0 AE 1.9 vs. 3.5 AE 1.4 kg; p ¼ 0.006) and 29% higher peak pressure (0.9 AE 0.2 vs. 0.7 AE 0.2 kg/cm 2 , p ¼ 0.018). No significant differences were found to exist between groups for any other plantar region. These findings indicate that OA of the first MPJ is associated with significant changes in load-bearing function of the foot, which may contribute to the development of secondary pathological changes associated with the condition, such as plantar callus formation and hyperextension of the hallux interphalangeal joint. The first metatarsophalangeal joint (first MPJ) consists of four articular facets including the first metatarsal head, the base of the proximal phalanx and the superior surfaces of the medial and lateral sesamoids. 1 Structurally, the first MPJ is classified as a single synovial condyloid joint that allows sagittal plane motion, primarily dorsiflexion, to occur about a horizontal axis. Approximately 65 to 75 degrees of dorsiflexion is considered necessary to enable efficient forward transfer of bodyweight during the propulsive phase of gait. 2-4 It has been hypothesized that restricted first MPJ motion can alter foot function, leading to first MPJ pain and the development of secondary pathological foot conditions such as plantar calluses. [2][3][4] Through repetitive loading during gait, the first MPJ is subject to a significant amount of stress, making it susceptible to the development of degenerative joint disease (osteoarthritis). Osteoarthritis (OA) is the leading cause of chronic pain and disability of older people in developed countries, 5 with OA of the first MPJ affecting 35 to 60% of the population aged over 65 years. 6 Depending on the severity of joint degeneration, OA of the first MPJ is termed hallux limitus or hallux rigidus. 7-13 Hallux limitus is defined as a condition in which there is restricted sagittal plane motion, whereas hallux...

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