1/2. Nonoperative and operative intervention for hallux rigidus.STUDY DESIGN: Case study of the management of an individual with hallux rigidus deformity. OBJECTIVE: To describe the outcome of nonoperative and operative treatment, including kinematic and kinetic changes following cheilectomy surgery, for an individual with hallux rigidus deformity. BACKGROUND: hallux rigidus is a common disorder of the first metatarsophalangeal joint characterized by progressive limitation of hallux dorsiflexion, prominent dorsal osteophyte formation, and pain. Surgery may be considered when nonoperative management strategies have proven unsuccessful. Kinematic and plantar pressure changes during dynamic activities have not been previously described following cheilectomy surgery for hallux rigidus deformity. methods AND MEASURES: The patient was a 54-year-old man who sustained a traumatic injury to the great toe. Conservative treatment included nonsteroidal anti-inflammatory drugs, custom insole fabrication, and footwear outersole modification. Because of continued pain, loss of motion, and restrictions in daily activities, the patient elected to have surgery, and a cheilectomy procedure was done. Presurgical and postsurgical kinematic data of first metatarsophalangeal joint motion were collected using an electromagnetic tracking device during clinical motion tests and walking. Peak plantar pressures were assessed during gait. The patient was evaluated preoperatively, at 6 months, and again at 18 months following surgery. RESULTS: The outcome of surgery proved favorable, both subjectively and objectively. Peak dorsiflexion increased significantly (a minimum of 20 degrees) for all clinical tests and walking trials at the first metatarsophalangeal joint when compared with preoperative measurements. Peak plantar pressures also increased over the medial forefoot (68%) and hallux (247%) between preoperative testing and follow-up, indicating increased loading to this region of the foot. CONCLUSIONS: Restrictions in motion and daily activities and persistent pain may warrant surgical intervention for individuals with hallux rigidus deformity. A successful outcome, as measured by the patient's self-reported pain, return to recreational activities, and kinematic and plantar pressure changes at the follow-up examination, was demonstrated in this case study.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/2. A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus.Forty-four patients (47 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Each foot was initially graded according to a four-stage hybrid hallux rigidus radiographic grading system. A subjective evaluation based on a modified American Orthopaedic foot and ankle Surgery clinical rating system was performed. An objective physical examination was performed. Angular and linear measurements were obtained from standard weightbearing radiographs. The extent of articular derangement for the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids were graded according to the American Orthopaedic foot and ankle Society intraoperative grading system. Finally, a means of quantifying the percentage of first metatarsal head articular derangement was performed. Significant differences were identified between joints radiographically classified as grade II, which had lower nonweightbearing, relaxed hanging position (p = .041); nonweightbearing assisted dorsiflexion (p = .000); actual nonweightbearing dorsal range of motion (p = .002); and actual plantar range of motion (p = .009) than those classified as grade I. The angle of deviation of the second metatarsophalangeal joint revealed a significant increase in degree of medial angulation as the grade increased (p = .000). None of the remaining radiographic measurements were significant. A correlation between the hybrid radiographic grading system and percentage of actual intraoperative articular derangement was shown to exist.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |