Hallux rigidus surgery

introduction

Of the Hallux rigidus describes an arthritic change with the associated increase in bony tissue at the metatarsophalangeal joint of the big toe, which can be very painful and significantly influences the movement or rolling process of the foot.

Hallux rigidus surgery

Basically, hallux rigidus is rarely the most promising conservative therapy and one most commonly applicable operative therapy at the Hallux Rigidus possible

The surgical techniques at a glance

Surgical therapy options for hallux rigidus:

• Cheilectomy:
  In the cheilectomy (see below) the bony cusp on the back of the foot (rose thorn-like spur) removed from the first metatarsal head and the joint edges smoothed. In addition, tendon adhesions are removed. If afterwards sufficient stretching is not possible, the base link is adjusted so that a good unwinding is possible.

• Provision of a prosthesis:
  Under certain conditions, a biocompatible artificial joint can be used. This combines good mobility with good foot handling. However, such an artificial joint can loosen up, which leads to follow-up operations. Unfortunately, the durability and resilience of these prostheses is limited.
• Operation according to Keller-Brandes:
  The Operation after Keller-Brandes (see below) is an operation that removes the joint, removing 1 / 3-2 / 3 of the base phalanx of the big toe. This procedure should only be used in elderly patients as it ignores biomechanics.
• Arthrodesis (stiffening) of the joint:
  For younger, physically active patients, selective fusion of the metatarsophalangeal joint of the big toe is recommended, which enables pain-free and powerful rolling. The movement in the end joint is retained

The cheilectomy

The Cheilectomy is an operative method for the treatment of hallux rigidus.
In hallux rigidus, the arthritic process leads to bony protrusions on the metatarsophalangeal joint of the big toe, which are felt to be very painful and disturbing in the course of movement. This is exactly where the cheilectomy begins therapeutically, in that the bony tumors, which occur in particular on the extensor side of the metatarsal head, are removed in one operation without interfering with the joint structure itself.

The aim is to remove the bony attachments that represent the problem of hallux rigidus, including the consequences, such as pain, an increased feeling of pressure on the metatarsophalangeal joint and the restriction in the rolling process of the foot.
As part of a cheilectomy, the bony axis of the metatarsophalangeal joint of the big toe can be corrected if necessary. The arthrosis of the metatarsophalangeal joint of the big toe is not influenced by the cheilectomy. Rather, this surgical intervention on the joint is another risk factor for the progression of osteoarthritis. Even so, the cheilectomy provides a good result in most cases. The treatment also includes a type of physiotherapy, which is intended to train and strengthen the metatarsophalangeal joint of the big toe so that the joint does not stiffen after the operation due to shortened ligament structures and the formation of scar tissue.

Operation after Keller-Brandes

Another method for Treatment of hallux rigidus represents the operation according to Keller-Brandes.
Here, the pathologically altered proximal (body-hugging) Part of the bone of the metatarsophalangeal joint including the bony attachments on the metatarsal bone caused by the osteoarthritis removed.
In contrast to Cheilectomy, the structure of the joint is clearly changed here. The advantage of Keller-Brandes operation is definitely the removal of the pain-causing and movement-restricting bony structure and the associated pressure relief on the metatarsophalangeal joint of the big toe. The shortening of the big toe associated with the removal of the bone portion and the reduced effect of the Flexor hallucis brevis muscle affect the outcome of the treatment.
The flexion of the foot in the direction of the sole of the foot can be severely impaired and the stability of the joint can be reduced. Thus, the operation according to Keller-Brandes is more recommended for patients who either have a very advanced or previously unsuccessfully pretreated hallux rigidus or are at an advanced age and have other foot malformations.
Young, active patients should choose an alternative therapy method.

Pain in hallux rigidus

The consequences of the arthritic changes in hallux rigidus include a narrowing of the joint space, an increase in bone tissue on the joint surface and pebbles under the cartilage layer.
Caused by osteoarthritis Impairments of the entire joint including mobility and strong pain. The reason for the pain is mainly the irritation of the joint capsule and the bones, which are both very well supplied with nerves, as part of the arthritic changes.
In particular, when the foot rolls, pain occurs, which causes the metatarsophalangeal joint of the big toe to be relieved.

Failure conservative methods, such as Painkiller or one rigid sole splint, a surgical intervention that affects the bony structures may be necessary. But this procedure is also associated with pain:

• For one, arise typical pain after the operation through wound healing.
• On the other hand, numerous structures are injured and irritated during the operation, for example the periosteum or nerves, some of which can cause pain beyond the period of wound healing.
• The joint may also have been changed by the operation in such a way that it was arthrosis no longer hurts, but has to learn a new movement due to the new structure of the joints and causes pain.

Sick leave after the operation

Depending on the course of the illness, at some point the time has come when the patients can no longer work due to the pathological process and they need a sick leave. The aim is to spare the hallux rigidus for a certain period of time and to begin therapy in order to then experience an improvement in the symptoms.
Sometimes it is even necessary to be on sick leave up to an operation and then for rehabilitation. However, this varies with the severity of the hallux rigidus and the job requirements.
Therefore, it is not possible to state a definite length of time for a sick leave.

Summary

Hallux rigidus can be treated conservatively with a rigid insert or pain medication, as well as surgically, for example by removing disturbing bone material.
There are several methods to choose from for surgical interventions, which are used depending on the severity and the patient.

1. A common surgical method is the so-called Arthrodesiswhich aims to stiffen the joint in question. This is done, for example, by inserting two screws over the joint space of the metatarsophalangeal joint of the big toe so that the joint-forming bones can no longer move against each other.
   The stiffening prevents the pain-inducing movement, but the rolling behavior of the foot is also impaired, which in turn can be compensated for by special shoes or physiotherapy.
2. Another method of treating hallux rigidus is this Insertion of an artificial joint, in the case of an endoprosthesis, which can be implemented as resurfacing, i.e. a replacement of the surface of the metatarsal head. Due to the optimized joint surfaces, both the restriction of movement and the resulting pain can be improved.
3. Alternatively, you can use a Cheilectomy treat hallux rigidus. Here, only the bony attachments on the joint surface of the big toe caused by the osteoarthritis are removed without changing the joint surface itself. This can improve the impairment of the mobility of the joint, which can also reduce the pain.
4. One method that is more of a last resort is surgery after Basement fire, in which the rear part of the metatarsophalangeal joint of the big toe is removed without replacement. However, there is a loss in the stability of the joint and the foot and in the flexion of the foot in the direction of the sole of the foot.

In summary, one can say that the surgical methods for treating hallux rigidus improve the problems of the bony structures and thereby alleviate the symptoms. Nevertheless, there may still be restrictions in movement and pain after the operation, although these are usually less pronounced than before.

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My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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