Cartilage degeneration with synovitis and joint space narrowing may develop. When nonoperative treatment has been unsuccessful in relieving pain and restoring function, surgery may be indicated. Since hallux rigidus represents a spectrum of joint pathology and symptomatology, it is not surprising that there is not one universally successful operative procedure for this condition. Evaluation of the patient's symptoms, activity demands, source of pain and radiographs are critical in order to determine which procedure to use. In this article, I will discuss my approach to symptomatic hallux rigidus with the use of case examples.
Radiographs reveal a prominent osteophyte on the metatarsal head.
The remainder of the joint space appears normal. A cheilectomy would be the most appropriate procedure for this patient. This can provide pain relief and increased joint motion without destroying the joint. A cheilectomy maintains the stability and function of the first ray and facilitates salvage of a failed procedure with an arthrodesis. Adequate bone should be removed from the metatarsal head in order to achieve increased dorsiflexion of the MTP joint.