Surgical Management of Hallux Rigidus Conditions

Hallux rigidus, a degenerative osteoarthritis of the first metatarsophalangeal joint, presents with progressive pain, reduced dorsiflexion and altered gait mechanics. When conservative measures such as footwear modification, orthoses or physiotherapy fail to provide lasting relief, surgical intervention becomes necessary. Contemporary management strategies are tailored to disease severity, ranging from joint-preserving dorsal cheilectomy and metatarsal decompression osteotomies to more invasive procedures including arthroplasty and joint fusion. Early-stage interventions aim to remove dorsal osteophytes and restore range of motion, while moderate disease may benefit from combined cheilectomy with an osteotomy to offload the joint. In advanced stages, partial or total joint replacement techniques or arthrodesis are selected based on patient activity level and alignment considerations. Minimally invasive and arthroscopic approaches have emerged to reduce soft-tissue disruption and accelerate recovery. Outcomes are assessed by pain scores, patient-reported function and measured range of motion, with an emphasis on maintaining gait efficiency and footwear compatibility. Global applicability of these techniques is supported by registry data and comparative studies, highlighting the importance of procedure selection in achieving durable symptom relief and functional restoration.

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Surgical Management of Hallux Rigidus Conditions publication trend

The graph below shows the total number of articles in surgical management of hallux rigidus conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Hallux rigidus: Osteoarthritic stiffening of the first metatarsophalangeal joint characterised by pain and limited dorsiflexion.

First metatarsophalangeal joint: The articulation between the first metatarsal head and proximal phalanx of the great toe, critical for propulsion during gait.

Cheilectomy: Surgical excision of dorsal osteophytes from the metatarsal head to improve joint range of motion.

Youngswick osteotomy: A decompression procedure involving a dorsal closing-wedge osteotomy of the first metatarsal to shift load and increase dorsiflexion.

Hemiarthroplasty: Partial joint replacement in which one articulating surface is resurfaced or replaced with a prosthetic implant.

Arthroscopic microhole drill technique: A minimally invasive method of creating small perforations in subchondral bone to stimulate repair and relieve pain in early cartilage lesions.

References

1. Comprehensive Review of Non-Operative Management of Hallux Rigidus. Cureus (2017).
2. Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot. Acta Orthopaedica (2020).
3. Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint. Journal of Orthopaedic Surgery and Research (2017).
4. Hállux Rígidus: estudo prospectivo da substituição articular com hemiartroplastia. Acta Ortopédica Brasileira (2013).