Skip to main content
SpringerLink
Log in

Mid- and long-term results of the joint preserving therapy of hallux rigidus

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The hallux rigidus is an over 100-year-known pathology. Yet an overall accepted therapy regime does not exist. The aim of this prospective study was to analyze the long-term clinical outcome and patient satisfaction of joint preserving operative care in patients with symptomatic hallux rigidus.

Methods

We present a prospective study with 60 patients (60 feet) with symptomatic hallux rigidus. In cases with intraoperative dorsiflexion of less than 70° after the cheilectomy, an additional Kessel–Bonney osteotomy was done. The first follow-up after 24 (10–31) months was done on 49 (81.7%) patients and the second after 96 (84–104) months on 46 (76.7%) patients. We recorded the pre- and post-operative Kitaoka score, range of motion, pain and patients satisfaction. The results were related to the operative procedure and the grade of hallux rigidus (according to Regnauld).

Results

Twenty patients were graded as I, 35 patients as II and 5 patients as III. At the follow-up, the mean dorsiflexion increased in grade I patients to about 21.7°, in grade II patients about 23.7° and in grade III patients about 26.3°. At the first follow-up [24 (10–31) months], all patients of grade I, 63.3% patients of grade II and 75% of grade III patients had just occasional or no pain. At the second follow-up [96 (84–104) months], 77.8% of grade I and 73.9% of grade II patients had no pain. At the first (second) follow-up 53.3% (61.1%) of grade I, 43.3% (33.3%) of grade II and 50% (25%) of grade III patients were completely satisfied. In order to the operative procedure the patients were completely satisfied or satisfied: first (second) follow-up 52% (85.9%) of patients with cheilectomy and 85% (86.4%) of patients with cheilectomy and Kessel–Bonney osteotomy. In 51.4% of the patients, the Kitaoka Score was higher than 70.4 points. Four patients had a persistent hypaesthesia of the medial side of the great toe and three patients had a delayed wound healing. No revision was necessary. No further operation was done in all the investigated patients.

Conclusion

The joint preserving operation in patients with grade I and II hallux rigidus shows an increase of dorsiflexion and decrease of daily pain. The long-term follow-up shows a persistent pain reduction and satisfaction of the patients. Our results recommend a joint preserving operation in grade I and II hallux rigidus. An additional osteotomy of the proximal phalanx should be done in cases of dorsiflexion less than 70° after cheilectomy.

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. Beertema W, Draijer WF, van Os JJ, Pilot P (2006) A retrospective analysis of surgical treatment in patients with symptomatic hallux rigidus: long-term follow-up. J Foot Ankle Surg 45:244–251

    Article  PubMed  Google Scholar 

  2. Coughlin MJ, Shurnas PS (2003) Hallux rigidus. Grading and long-term results of operative treatment. J Bone Jt Surg Am 85-A:2072–2088

    Google Scholar 

  3. Coughlin MJ, Shurnas PS (2003) Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 24:731–743

    PubMed  Google Scholar 

  4. Derner R, Goss K, Postowski HN, Parsley N (2005) A plantar-flexor-shortening osteotomy for hallux rigidus: a retrospective analysis. J Foot Ankle Surg 44:377–389

    Article  PubMed  Google Scholar 

  5. Foliart DE (1997) Synovitis and silicone joint implants: a summary of reported cases. Plast Reconstr Surg 99:245–252

    Article  CAS  PubMed  Google Scholar 

  6. Fuhrmann RA, Anders JO (2001) The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop 25:312–316

    Article  CAS  PubMed  Google Scholar 

  7. Geldwert JJ, Rock GD, McGrath MP, Mancuso JE (1992) Cheilectomy: still a useful technique for grade I and grade II hallux limitus/rigidus. J Foot Surg 31:154–159

    CAS  PubMed  Google Scholar 

  8. Giannini S, Ceccarelli F, Faldini C, Bevoni R, Grandi G, Vannini F (2004) What’s new in surgical options for hallux rigidus? J Bone Jt Surg Am 86-A(Suppl 2):72–83

    Google Scholar 

  9. Hamilton WG, Hubbard CE (2000) Hallux rigidus. Excisional arthroplasty. Foot Ankle Clin 5:663–671

    CAS  PubMed  Google Scholar 

  10. Jack EA (1940) The aetiology of hallux rigidus. Br J Surg 27:492–497

    Article  Google Scholar 

  11. Jansen MJ (2008) Hallux valgus, rigidus and malleus. J Orthop Surg 3:87–90

    Google Scholar 

  12. Keiserman LS, Sammarco VJ, Sammarco GJ (2005) Surgical treatment of the hallux rigidus. Foot Ankle Clin 10:75–96

    Article  PubMed  Google Scholar 

  13. Kessel L, Bonney G (1958) Hallux rigidus in the adolescent. J Bone Jt Surg Br 40:669–673

    Google Scholar 

  14. Lambrinudi C (1938) Metatarsus primus elevatus. Proc R Soc Med 31:1273

    PubMed  CAS  Google Scholar 

  15. Mann RA, Coughlin MJ, DuVries HL (1979) Hallux rigidus: a review of the literature and a method of treatment. Clin Orthop Relat Res 57–63

  16. McMurray TP (1936) Treatment of hallux valgus and rigidus. Br Med J 2:218–221

    Article  Google Scholar 

  17. Moberg E (1979) A simple operation for hallux rigidus. Clin Orthop Relat Res 55–56

  18. Nilsonne H (1930) Hallux rigidus and is treatment. Acta Orthop Scand 1:295–303

    Article  Google Scholar 

  19. Pittman SR, Burns DE (1984) The Wilson bunion procedure modified for improved clinical results. J Foot Surg 23:314–320

    CAS  PubMed  Google Scholar 

  20. Regnauld B (1986) Disorders of the great toe. In: Regnauld B (ed) The foot: pathology, aetiology, semiology. clinical investigation and treatment. Springer, Berlin, pp 345–359

    Google Scholar 

  21. Roukis TS, Jacobs PM, Dawson DM, Erdmann BB, Ringstrom JB (2002) A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis. J Foot Ankle Surg 41:158–165

    Article  PubMed  Google Scholar 

  22. Thomas PJ, Smith RW (1999) Proximal phalanx osteotomy for the surgical treatment of hallux rigidus. Foot Ankle Int 20:3–12

    CAS  PubMed  Google Scholar 

  23. Wingenfeld C, Abbara-Czardybon M, Arbab D, Frank D (2008) Cheilectomy and Kessel–Bonney procedure for treatment of initial hallux rigidus. Oper Orthop Traumatol 20:484–491

    Article  PubMed  Google Scholar 

  24. Youngswick FD (1982) Modifications of the Austin bunionectomy for treatment of metatarsus primus elevatus associated with hallux limitus. J Foot Surg 21:114–116

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Orthopedic Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Hazibullah Waizy, C. Stukenborg-Colsman, M. Wellmann & H. Windhagen

  2. Orthopedic and Trauma Department, Remigius-Hospital-Opladen, An St. Remigius 26, 51379, Leverkusen-Opladen, Germany

    M. Abbara Czardybon, C. Wingenfeld & D. Frank

Authors
  1. Hazibullah Waizy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Abbara Czardybon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Stukenborg-Colsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Wingenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Wellmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Windhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Frank
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hazibullah Waizy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waizy, H., Abbara Czardybon, M., Stukenborg-Colsman, C. et al. Mid- and long-term results of the joint preserving therapy of hallux rigidus. Arch Orthop Trauma Surg 130, 165–170 (2010). https://doi.org/10.1007/s00402-009-0857-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-009-0857-1

Keywords

Search

Navigation