Search Results (14)

Background: Arthrodesis of the first metatarsophalangeal joint (MTP1) is a common intervention for hallux rigidus (HR). The procedure eliminates MTP1 motion but results in significant pain relief and high satisfaction rates, although MTP1 is eliminated. Less evidence is available regarding the effects on gait and the presence of compensatory mechanisms. The aim of this study is to investigate the effects of MTP1 arthrodesis on gait and patient-reported outcome measures (PROMs) compared with preoperative functioning and healthy individuals. Methods: In this prospective study, 10 patients (10 feet) with HR who underwent MTP1 arthrodesis were evaluated before and after surgery and compared with 15 healthy controls (30 feet). Gait analysis was performed with a motion capturing system using the multi-segment Oxford foot model. Spatiotemporal parameters and kinematics were quantitatively analyzed. PROMs were evaluated using validated questionnaires including the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale, the Numeric Pain Rating Scale (NPRS), and the Manchester–Oxford Foot Questionnaire (MOXFQ). Results: MTP1 joint motion was reduced in HR and further reduced after MTP1 arthrodesis compared with healthy controls. Furthermore, intersegmental ROM analysis revealed increased forefoot frontal plane motion (pronation and supination) in HR compared with healthy controls. This was also observed after MTP1 arthrodesis, while additionally increased frontal plane motion in the hindfoot (inversion and eversion) was observed compared with HR and healthy controls. PROM evaluation revealed improved AOFAS-HMI (from 55.7 to 79.1 points, p = 0.002) and NPRS (from 5.7 to 1.5 points, p = 0.004) scores after surgery. Additionally, improvements in the MOXFQ score (from 51.0 to 20.0 points, p = 0.002) were observed. Conclusions: Due to the loss of sagittal hallux motion, foot and ankle kinematics are changed in HR patients and after MTP1 arthrodesis compared with healthy controls. Loss of MTP1 motion results in increased frontal plane motion of the forefoot in HR, and increased frontal plane motion of the fore- and hindfoot after MTP1 arthrodesis. Additionally, substantial improvements in PROMs were recorded after surgery. Full article

Background: Hallux rigidus (HR) is a common forefoot disorder, and surgical treatment is typically guided by the severity of the condition, as defined by the Coughlin and Shurnas four-grade classification. This study aimed to compare clinical and functional outcomes in patients undergoing first metatarsophalangeal joint arthrodesis (FMTPJA) with or without the use of an interfragmentary (IF) screw in addition to a dorsal plate. Methods: We retrospectively evaluated a cohort of patients who underwent surgery with a FMTPJA, dividing patients in two groups: patients who underwent FMTPJA through dorsal plate associated with an interfragmentary screw (WIS group) and patients who underwent FMTPJA through dorsal plate without an interfragmentary screw (WOIS group). The primary outcomes were analyzed using the FAAM score and FAAM sport score. Secondary outcomes included VAS, patient satisfaction, recovery time to return to sports, and the level of postoperative sports activity compared to preoperative levels. Results: In paired analyses, the WOIS group showed statistically significant improvements in both the FAAM and FAAM sport scores (p = 0.01). In contrast, the WIS group showed significant improvement only in the FAAM sport score (p = 0.01), while the FAAM score did not reach statistical significance (p = 0.42). Multivariate analysis revealed that a higher preoperative FAAM score predicted a higher postoperative FAAM score (p = 0.75), while the use of an IF screw was associated with a lower expected postoperative FAAM score (p = 0.25). Increased BMI and older age were significantly associated with lower postoperative FAAM scores. Conclusions: Both surgical techniques led to significant clinical improvements. However, patients in the WOIS group showed a trend toward faster recovery and higher postoperative sports activity levels, particularly in the athletic population. Although no statistically significant differences were found between groups overall, these findings suggest potential benefits of avoiding an IF screw in selected patients. Further prospective studies are warranted to better delineate the clinical impact of screw usage in FMTPJA. Full article

Background: Hallux rigidus is a painful and degenerative pathology of the first metatarsophalangeal (MTP1) joint. In severe cases it is usually appropriate to consider arthrodesis or arthroplasty of the joint. Arthrodesis represents the gold standard, but arthroplasty allows patients to recover mobility. Although arthroplasty has slightly inferior functional results to arthrodesis, it has shown very good results in terms of joint mobility, patient satisfaction and pain reduction. The goal of the present study was to evaluate short-term outcomes of patients that received a third-generation double-stemmed MTP1 implant manufactured from high-performance silicon. Methods: In this retrospective study the authors analyzed data of 37 patients who underwent MPT1 joint arthroplasty with Silktoe^TM double-stemmed implant using the R 4.2.2 software (R Foundation for Statistical Computing, Vienna, Austria). The indications were hallux rigidus of grade III and grade IV (81.1%), hallux rigidus plus valgus (10.8%), painful or unstable joint following previous surgery (5.4%) and hallux rigidus due to gout (2.7%). Data were collected during routine visits at 1 and 6 months and 1 and 2 years. Results: There were no intraoperative and postoperative complications. There were no revisions or reoperations at a follow-up of two years. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS-HMI) score was 94.6 ± 7.6 (median, 100; range, 70–100) and the Visual Analogue Scale (VAS) score was 0.4 ± 0.80 (median, 0; range, 0–3.5) at the final follow-up. Conclusions: The data from this study presented excellent short-term results for patients who received an arthroplasty of the MTP1 joint using a third-generation double-stemmed spacer made of high-performance silicone. For all patients who received the Silktoe^TM implant, AOFAS-HMI scores of 94.6 and VAS scores of 0.4 were obtained at a two-year follow-up. These values were in line with results reported in the literature for similar devices. Full article

Background: In 1927, Cochrane observed persistent elastic resistance to hallux dorsiflexion after cheilectomy for hallux rigidus, attributing it to soft tissue tightness beneath the first metatarsophalangeal (MTP) joint. An innovative surgery was introduced using a plantar approach, dividing the plantar tissues. This procedure achieved complete pain resolution and high satisfaction in 12 patients. Despite addressing the etiology of hallux rigidus, this approach has not been adopted in current surgeries. This report presents a case treated with the arthroscopic Cochrane procedure with a long-term follow-up. Methods: A 73-year-old male with hallux rigidus presented with limited dorsiflexion, a painful bony prominence, and pain during walking at the first MTP joint, treated with the arthroscopic Cochrane procedure. Results: During surgery, hallux dorsiflexion did not improve after resecting all spurs in the MTP joint, but the dorsiflexion angle immediately improved from 55° to 85°after releasing the flexor hallucis brevis tendon, plantar capsule, and plantar portion of the lateral ligament. Improvements in both visual analog scale scores (70–0) and Japanese Society for Surgery of the Foot scores (57–88) were noted from preoperatively to 9 years and 6 months postoperatively. No postoperative cockup deformity was observed. Conclusions: The arthroscopic Cochrane procedure can yield favorable long-term outcomes without postoperative cockup deformity. Full article

In 1927, Cochrane noted that elastic resistance to dorsiflexion of the hallux was retained after the cheilectomy or dorsiflexion osteotomy of the metatarsal head and speculated that the shortening and tightness of the soft tissues below the first metatarsophalangeal joint would be the etiology of hallux rigidus. He devised a novel surgery in which the plantar tissues were divided using a plantar approach and reported good results in 12 patients with the disappearance of elastic resistance during dorsiflexion and with no recurrence. Although he identified the etiology of hallux rigidus and developed a revolutionary surgery that directly addressed the etiology, this approach has not yet been seen in current surgeries. Therefore, we hypothesized that current surgeries for hallux rigidus lack rationality regarding etiology and aimed to critically review joint-preserving surgeries based on etiology. First, we summarized the literature on proposed causes and explained how the condition progresses from shortened, tightened plantar soft tissues. We then reviewed joint-preserving surgeries in terms of etiology and treatment efficacy and finally mentioned the arthroscopic Cochrane procedure as a promising option. Full article

Background: Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid. Methods: Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen’s metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw. Results: The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37–51.5) to 58° (range, 49–69.5) degrees of loaded dorsiflexion (p > 0.006); (2) 41° (range, 40–51.5) to 58° (range, 52.5–66.5) degrees of unloaded dorsiflexion (p > 0.009); and (3) 14° (range, 10.5–24.25) to 16° (range, 14.25–28.5) degrees of unloaded plantarflexion (p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections. Conclusions: The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures. Full article

Background: Cheilectomy is a joint-sparing surgery for the treatment of moderate stages of Hallux Rigidus (HR). The purpose of this systematic review was to assess the clinical outcomes, range of motion (ROM), complications, and revision rates associated with cheilectomy. Methods: A literature search of the PubMed, Scopus, and Cochrane databases was performed. PRISMA guidelines were used. Risk of bias was assessed through the Newcastle–Ottawa Scale. Meta-analysis of the clinical outcomes scores was performed. Results: The initial search identified 317 articles, with 16 included. Cheilectomy improved ROM by 51.15% (41.23° to 62.32°), with greater gains in traditional (67.72%) vs. minimally invasive (48.74%) techniques. VAS decreased by 72.61%, more in traditional (79.35%) than minimally invasive (64.97%). AOFAS improved by 33.99%, from 61.83 to 82.85. Complications occurred in 11% (11.68% traditional, 9.73% minimally invasive), with residual pain (7.46%) more common in traditional and nerve injury (3.78%) in minimally invasive procedures. Revision rates were 7.4% overall (6.1% traditional, 8.8% minimally invasive). Conclusions: This procedure showed satisfactory results regardless of whether the traditional or minimally invasive technique is used. Current evidence does not allow for a definitive indication, but careful patient selection is advisable, particularly for mild to moderate cases. Full article

Since the early 2000s, minimally invasive forefoot surgery (MIS), particularly hallux valgus correction, has significantly advanced with the introduction of the Shannon burr. However, despite numerous relevant studies being published, no comprehensive review articles have summarized MIS for various forefoot conditions. Therefore, in this comprehensive review, we examined the relevant studies about the application of MIS (excluding arthroscopy and endoscopy) for various forefoot conditions. Additionally, we discuss the essential considerations for achieving favorable surgical outcomes and preventing complications associated with each technique. We analyzed the characteristics of each surgical procedure and identified areas for future focus. Effective surgical treatment not only requires MIS, but also the appropriate selection of patients based on suitable indications and executing procedures within the surgeon’s capabilities. We hope that this review will help readers to enhance their expertise in this field. Full article

In this article, the authors review the role of ultrasound guidance in MSK mini-invasive surgery. Ultrasound imaging has become an important tool in the field of musculoskeletal examination and has advantages over the X-ray guidance traditionally used by orthopaedic surgeons. Ultrasound provides the 3D localization of the area where the instruments are being used, does not require X-ray’s certified personnel, and poses less of a health risk to the patient and the medical staff. This article explores the development and application of ultrasound navigation in mini-invasive surgery, including the use of ultrasound during different stages of arthroscopic procedures or for the entire operation. Ultrasounds can assist in setting access points around the joint, localize the pathology and assure its complete resection, identify vessels and nerves, establish access to and constant control of difficult operating areas with a high potential for neurovascular complications. In this paper, the authors also acknowledge that there are some disadvantages, including the need for additional equipment and personnel, a long learning curve, and the potential elongation of the procedure. To identify all of the essential studies that report relevant information and data concerning the ultrasounds navigation in mini-invasive MSK surgery, an extensive search of the major and significant electronic databases was performed by two authors. An investigation was conducted in January 2023 using the following key terms: ultrasounds navigation, ultrasounds in arthroscopy, ultrasounds in MSK, with no limits regarding the year of publication. The authors focused both on the advantages and disadvantages of ultrasound navigation in MSK mini-invasive surgery, and also on particular techniques in mini-invasive and arthroscopic surgeries. The described techniques are the application of ultrasound in arthroscopy (knee, hip, and shoulder), hallux rigidus surgery, mini-invasive Achilles tendon surgery, gastrocnemius recession, carpal tunnel release, and hematoma evacuation. Full article

Study design, case-control study: Background, Morton’s extension (ME) is a kind of orthotic that has been used as a conservative treatment of painful hallux rigidus (HR) osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied pulled tension forces neither in subjects with HR. Objectives: This study sought to understand how ME’s orthotics with three different thicknesses could influence the kinematic first MPJ by measuring hallux dorsiflexion using Jack’s test and a digital algometer with a rigid strip anchored to the iron hook’s extremity and comparing subjects with healthy first MPJ mobility to those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects. Methods: Fifty-eight subjects were selected, of whom thirty were included in the case group according to HR criteria and twenty-eight were included in the control group. A digital algometer (FPX^®® 25, Wagner Instruments^®®, Greenwich, CT, USA) was used to assess the pulled tension values (kgf) of the first MPJ during Jack’s test. Results: The pulled tension values were highly reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different ME conditions in the case (p = 0.969) or control (p = 0.718) groups. However, as it’s expected, there were statistically significant differences comparing all pulled tension values between case and control group subjects (p < 0.001). Conclusions: Different ME’s thicknesses had no influence on the pulled effort applied during the dorsiflexion Jack’s test between the healthy and HR groups; therefore, it can be prescribed without joint-care danger. In addition, it is proven that there is greater resistance to performing Jack’s test in the HR group than in the healthy group, regardless of ME’s orthotics. Furthermore, it is shown that the digital algometer device is a valid tool to detect the first MPJ restriction and is more reliable than other tests. Full article

Hallux rigidus is degenerative arthritis of the first metatarsophalangeal joint characterized by pain and stiffness in the joint with limitation of motion and functional impairment. Recently, bone grafts have been introduced in orthopedic procedures, namely osteosynthesis and arthrodesis. Allografts can induce bone formation, provide support for vascular and bone ingrowth and have a low risk of immunological rejection. A 52-year-old female patient with hallux rigidus underwent arthrodesis of the first metatarsophalangeal joint using Shark Screw^® made of allogenic cortical bone. Corrective surgery was performed after 10 weeks, and a 5 × 3 mm large part of the Shark Screw^® with the surrounding patient’s bone was removed. A histological evaluation revealed a vascularized graft with the newly formed compact lamellar bone fitting exactly to the cortical graft. The bone surface was lined by plump osteoblasts with osteoid production, and osteocytes were present in the lacunae. The arthrodesis of the first metatarsophalangeal joint using an allogenic cortical bone graft results in fast, primary bone healing without immunological rejection. This case suggests that the cortical allograft is a good and safe treatment option with an excellent graft incorporation into the host bone. However, as the literature evaluating the histology of different bone grafts is scarce, further high-level evidence studies with adequate sample sizes are needed to confirm our findings. Full article

Background: The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. Purpose: The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. Materials and Methods: In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0° until 30° every 5° on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. Results: We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20° of inclination (p < 0.001). The interobserver agreement showed good agreement at 0°, 5°, 10°, 20°, and 25° and was excellent at 30° (p < 0.001). Conclusion: All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made. Full article

Hallux rigidus (HR) is a progressive degenerative pathology affecting the first metatarsophalangeal joint. The aim of the present study is to report our experience on the treatment of HR patients with two different surgical methods: arthrodesis and hemiarthroplasty. Twelve patients (14 HR) underwent surgery for HR from July 2004 to October 2009. Median age was 58 years (Interquartile Range (IQR) 52.75–65.0). At time of surgery, patients had different grades of HR, according to the Regnauld modified classification. The outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (HMI) scale. Controls were performed at one month and then at mid-term follow-up (median 48 months; IQR 29.3–58.0). In the arthrodesis group (n = 6 HR) we observed a median improvement of 35.5 points (IQR 34.75–36.0; p = 0.036) at the early follow-up. In the hemiarthroplasty (n = 8 HR) group the median of differences at the one-month follow-up was 33 (IQR 30.5–33.0; p = 0.022). At mid-term follow-up the arthrodesis group showed the median difference score of 35 (IQR 33.0–35.25) in comparison with the hemiarthroplasty group which showed a median score of 30.5 (IQR 28.0–32.5). Our results are consistent with the current understanding of two surgical techniques for the treatment of HR: nowadays, arthrodesis is considered the treatment of choice in grade III and IV. Hemiarthroplasty seems to be a promising option. Management of pain and joint flexibility are fundamental to prevent relapses and restore the Range Of Motion (ROM) in dorsal flexion. This article is a retrospective case series with a level of evidence 4. Full article

We report a case of a 65-year-old man with a painful nonunion of the first metatarsophalangeal joint (MTPJ). It is one of the main severe complications of this surgery. Its prevalence is described between 5% and 10% across different operative techniques. The implantation of hemicup-prosthesis has been successfully used for the hallux rigidus treatment with very promising results. In our case report, we introduce a treatment method of converting a pseudoarthrosis of the first MTPJ, made of two crossing screws into a hemicup-prosthesis as a salvage procedure. This is to our best knowledge the first report using this device for treatment of pseudoarthrosis of the first MTPJ. Full article