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Abstract
In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus. Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Hallux Rigidus | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Hallux Rigidus\r | vii | ||
| Hallux Rigidus: Relevant Anatomy and Pathophysiology\r | vii | ||
| Clinical Presentation and Management of Hallux Rigidus\r | vii | ||
| Hallux Rigidus: Nonoperative Treatment and Orthotics\r | vii | ||
| First Metatarsophalangeal Joint Degeneration: Arthroscopic Treatment\r | viii | ||
| Open, Arthroscopic, and Percutaneous Cheilectomy for Hallux Rigidus\r | viii | ||
| Moberg Osteotomy for Hallux Rigidus\r | viii | ||
| Resurfacing of the Metatarsal Head to Treat Advanced Hallux Rigidus\r | viii | ||
| Metatarsophalangeal Joint Fusion: Why and How?\r | viii | ||
| Metatarsophalangeal Fusion Techniques with First Metatarsal Bone Loss/Defects\r | ix | ||
| The Use of Osteotomy in the Management of Hallux Rigidus\r | ix | ||
| Proximal Phalanx Hemiarthroplasty for the Treatment of Advanced Hallux Rigidus\r | ix | ||
| Operative Technique: Interposition Arthroplasty and Biological Augmentation of Hallux Rigidus Surgery\r | ix | ||
| FOOT AND ANKLE CLINICS\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| December 2015 | xi | ||
| March 2016 | xi | ||
| June 2016 | xi | ||
| September 2016 | xi | ||
| RECENT ISSUES | xi | ||
| June 2015 | xi | ||
| March 2015 | xi | ||
| December 2014 | xi | ||
| September 2014 | xi | ||
| Preface\r | xiii | ||
| Hallux Rigidus | 381 | ||
| Key points | 381 | ||
| INTRODUCTION | 381 | ||
| ANATOMY AND KINEMATICS OF THE HALLUX METATARSOPHALANGEAL JOINT COMPLEX | 382 | ||
| CLINICAL FEATURES OF HALLUX RIGIDUS | 383 | ||
| CLINICAL ETIOLOGIC FACTORS | 383 | ||
| Trauma | 384 | ||
| First Ray Hypermobility | 384 | ||
| Metatarsus Primus Elevatus | 384 | ||
| Family History | 384 | ||
| Equinus and Pes Planus | 385 | ||
| Hallux Valgus | 385 | ||
| Hallux Valgus Interphalangeus | 385 | ||
| COMMON ASSOCIATED RADIOGRAPHIC FINDINGS | 385 | ||
| Flat or Chevron-Shaped Metatarsal Head | 385 | ||
| Metatarsal Osteochondritis Dessicans | 386 | ||
| Metatarsal Length | 386 | ||
| SUMMARY | 388 | ||
| SUPPLEMENTARY DATA | 388 | ||
| REFERENCES | 388 | ||
| Clinical Presentation and Management of Hallux Rigidus | 391 | ||
| Key points | 391 | ||
| INTRODUCTION | 391 | ||
| CLINICAL PRESENTATION | 392 | ||
| IMAGING | 392 | ||
| CLASSIFICATION | 393 | ||
| TREATMENT | 393 | ||
| Nonsurgical Management | 393 | ||
| Surgical Management | 394 | ||
| Joint-preserving procedures | 395 | ||
| Joint-altering procedures | 396 | ||
| SUMMARY | 397 | ||
| REFERENCES | 397 | ||
| Hallux Rigidus | 401 | ||
| Key points | 401 | ||
| INTRODUCTION | 401 | ||
| CAUSE | 402 | ||
| BIOMECHANICS AND PATHOPHYSIOLOGY | 403 | ||
| CLINICAL PRESENTATION AND GRADING | 403 | ||
| RADIOLOGICAL FINDINGS AND GRADING | 404 | ||
| NONOPERATIVE TREATMENT OF HALLUX RIGIDUS | 404 | ||
| Manipulation Under Anesthesia and Joint Injections | 405 | ||
| Shoe Modifications and Orthotics | 407 | ||
| Physical Therapy | 409 | ||
| Experimental Therapy | 410 | ||
| SUMMARY | 410 | ||
| REFERENCES | 410 | ||
| First Metatarsophalangeal Joint Degeneration | 413 | ||
| Key points | 413 | ||
| INTRODUCTION | 413 | ||
| FIRST METATARSOPHALANGEAL ARTHROSCOPY | 414 | ||
| Indications | 415 | ||
| Contraindications | 415 | ||
| Preoperative Planning | 415 | ||
| SETUP AND SURGICAL TECHNIQUE | 415 | ||
| SUMMARY | 419 | ||
| REFERENCES | 419 | ||
| Open, Arthroscopic, and Percutaneous Cheilectomy for Hallux Rigidus | 421 | ||
| Key points | 421 | ||
| INTRODUCTION | 421 | ||
| Evaluation for Minimal Access Joint-Preserving Surgery | 422 | ||
| OPEN CHEILECTOMY | 423 | ||
| Surgical Technique | 423 | ||
| Technical Variations | 424 | ||
| Results | 424 | ||
| ARTHROSCOPIC CHEILECTOMY | 426 | ||
| Surgical Technique | 426 | ||
| Technical Variations | 426 | ||
| Results | 427 | ||
| PERCUTANEOUS CHEILECTOMY | 427 | ||
| Surgical Technique | 427 | ||
| Results | 429 | ||
| SUMMARY | 429 | ||
| REFERENCES | 429 | ||
| Moberg Osteotomy for Hallux Rigidus | 433 | ||
| Key points | 433 | ||
| INTRODUCTION | 433 | ||
| Background | 433 | ||
| Pathophysiology and Cause | 434 | ||
| History and Clinical Findings | 434 | ||
| Diagnostic Studies and Staging | 435 | ||
| Conservative Treatment | 436 | ||
| INDICATIONS/CONTRAINDICATIONS | 436 | ||
| Indications | 436 | ||
| Contraindications | 436 | ||
| SURGICAL TECHNIQUE | 437 | ||
| Preoperative Planning | 437 | ||
| Prep and Patient Positioning | 437 | ||
| Surgical Approach | 438 | ||
| Surgical Procedure | 438 | ||
| 1: cheilectomy | 438 | ||
| 2: Moberg osteotomy | 439 | ||
| 3: fixation | 442 | ||
| COMPLICATIONS AND MANAGEMENT | 443 | ||
| POSTOPERATIVE CARE | 446 | ||
| OUTCOMES | 447 | ||
| SUMMARY | 447 | ||
| REFERENCES | 448 | ||
| Resurfacing of the Metatarsal Head to Treat Advanced Hallux Rigidus | 451 | ||
| Key points | 451 | ||
| INTRODUCTION | 451 | ||
| INDICATIONS | 452 | ||
| SURGICAL TECHNIQUE | 452 | ||
| Preoperative Planning | 452 | ||
| Surgical Procedure | 453 | ||
| Postoperative Care | 456 | ||
| Complications | 458 | ||
| OUTCOMES | 459 | ||
| SUMMARY | 459 | ||
| REFERENCES | 461 | ||
| Metatarsophalangeal Joint Fusion | 465 | ||
| Key points | 465 | ||
| INTRODUCTION | 465 | ||
| INDICATIONS AND CONTRAINDICATIONS | 466 | ||
| SURGICAL TECHNIQUE AND PROCEDURE | 466 | ||
| Preoperative Planning | 466 | ||
| Preparation and Patient Positioning | 467 | ||
| Surgical Approach | 467 | ||
| Surgical Procedure | 468 | ||
| Step 1: preparation of the joint surfaces | 468 | ||
| Step 2: defect filling | 469 | ||
| Step 3: realignment and internal fixation | 469 | ||
| Postoperative Care | 472 | ||
| COMPLICATIONS AND MANAGEMENT | 473 | ||
| OUTCOMES | 473 | ||
| SUMMARY | 475 | ||
| REFERENCES | 475 | ||
| Metatarsophalangeal Fusion Techniques with First Metatarsal Bone Loss/Defects | 479 | ||
| Key points | 479 | ||
| INTRODUCTION | 479 | ||
| INDICATIONS/CONTRAINDICATIONS | 482 | ||
| Preoperative Planning | 483 | ||
| SURGICAL TECHNIQUE | 484 | ||
| Prep and Positioning the Patient | 484 | ||
| Surgical Approach | 484 | ||
| Surgical Procedure | 484 | ||
| SELECTING THE GRAFT SIZE | 486 | ||
| ILIAC CREST TRICORTICAL HARVEST TECHNIQUE | 486 | ||
| GRAFT FIXATION | 486 | ||
| Complications and Management | 488 | ||
| Postoperative Care | 489 | ||
| Outcomes | 489 | ||
| SUMMARY | 490 | ||
| REFERENCES | 491 | ||
| The Use of Osteotomy in the Management of Hallux Rigidus | 493 | ||
| Key points | 493 | ||
| INTRODUCTION | 493 | ||
| CLASSIFICATION | 494 | ||
| PATHOLOGY | 494 | ||
| DIAGNOSIS OF FUNCTIONAL HALLUX RIGIDUS | 495 | ||
| MANAGEMENT | 495 | ||
| SURGICAL MANAGEMENT | 496 | ||
| DISTAL METATARSAL OSTEOTOMIES | 496 | ||
| Watermann-Green Osteotomy | 496 | ||
| The Authors’ Preferred Technique: Youngswick Osteotomy | 497 | ||
| OBLIQUE DISTAL METATARSAL OSTEOTOMY | 498 | ||
| The Authors’ Preferred Indications and Technique | 498 | ||
| PROXIMAL METATARSAL OSTEOTOMY | 499 | ||
| MODIFIED LAPIDUS PROCEDURE | 500 | ||
| SUMMARY | 501 | ||
| REFERENCES | 502 | ||
| Proximal Phalanx Hemiarthroplasty for the Treatment of Advanced Hallux Rigidus | 503 | ||
| Key points | 503 | ||
| INTRODUCTION | 503 | ||
| INDICATIONS | 505 | ||
| CONTRAINDICATIONS | 505 | ||
| PREOPERATIVE PLANNING | 506 | ||
| OPERATIVE TECHNIQUE | 506 | ||
| POSTOPERATIVE MANAGEMENT | 507 | ||
| DISCUSSION | 508 | ||
| SUMMARY | 510 | ||
| REFERENCES | 510 | ||
| Operative Technique | 513 | ||
| Key points | 513 | ||
| INTRODUCTION | 513 | ||
| SURGICAL TECHNIQUE/PROCEDURE | 516 | ||
| Preoperative Planning | 516 | ||
| Patient Positioning | 516 | ||
| Surgical Approach | 516 | ||
| Surgical Procedure | 516 | ||
| PUBLISHED MODIFICATIONS | 518 | ||
| Tendon Autograft Interposition | 518 | ||
| Regenerative Tissue Matrix | 519 | ||
| Fetal Amniotic Tissue Augmentation | 520 | ||
| POSTOPERATIVE DRESSING | 521 | ||
| Dressing | 521 | ||
| POSTOPERATIVE CARE | 522 | ||
| OUTCOMES | 522 | ||
| OUTCOMES OF MODIFIED TECHNIQUES | 523 | ||
| SUMMARY | 523 | ||
| REFERENCES | 523 | ||
| Index | 525 |