Guidelines for surgical treatment of hallux rigidus.

Hallux rigidus is a limitation of dorsiflexion of the first metatarsophalangeal joint associated with pain, and its treatment remains a debated topic in orthopaedic surgery. Most authors have recommended resection arthroplasty of the first metatarsophalangeal joint in the past, but others, more recently have presented good results with cheilectomy, various types of osteotomies and arthrodeses or bioreabsorbable implants. The aim of this video is to present guidelines for surgical treatment of hallux rigidus, recently published by the authors showing step by step clinical and X-ray evaluation, classification, algorithm of treatment and different surgical techniques, based on the reviewing 111 consecutive feet operated. Labelling factors of each case were considered for classification. In cases of hallux rigidus without arthritis, surgical treatment consisted in plantar release. In cases with a grade 1 hallux rigidus, surgical treatment consisted in distal decompressive osteotomies. In cases with a grade 2 hallux rigidus, surgical treatment consisted in cheilectomy. In cases with a grade 3 hallux rigidus, surgical treatment consisted in arthrodesis or resection arthroplasty using bioreabsorbable implant. Immediate weight-bearing was allowed with talus shoes for 4 weeks. Results are presented of patients clinically and radiographically checked at an average follow-up of 6 years. The mean clinical pre-operative AOFAS score was 42+14, while at follow-up it was 81+9. The mean pre-operative metatarsophalangeal range of motion was 27+17°, while at follow-up it was 75+8°. Surgical treatment of hallux rigidus depends on its pathoanatomy, and the precise evaluation of labelling factors is the key point to obtain optimal results.