Rhena Clinic

Interventions

Hallux Rigidus

When osteoarthritis occurs in the first metatarsophalangeal joint, it is called HALLUX RIGIDUS. This condition involves bony growths around the affected joint, leading to an increase in joint volume and causing pain from friction when wearing shoes.

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Hallux Rigidus

Hallux rigidus is the name given to primary osteoarthritis of the first metatarsophalangeal joint, as well as between the head of the first metatarsal and its sesamoids.

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Hallux Valgus

The most common deformity is HALLUX VALGUS (commonly called the "bunion"). It affects the first ray of the foot, where the phalanges are deviated outward and the first metatarsal (the long bone on the inner edge of the foot) is deviated inward.

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Hip

Hip wear is often accompanied by reduced joint amplitude (stiffness) and, above all, pain.

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Knee

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Hallux Rigidus

In Brief

Hallux rigidus is a form of osteoarthritis affecting the big toe joint, causing stiffness and pain, even at rest. Over time, bony outgrowths (osteophytes) may appear, making it painful to put on shoes.

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Causes

This condition is often caused by age-related joint wear or anatomical predisposition. It can also be aggravated by hallux valgus or other foot deformities.

Intervention

Depending on severity, treatment may be conservative, to preserve the joint, or radical, with arthrodesis (joint fusion) to relieve pain.

Recovery

After the operation, a bandage is worn for 3 weeks and a rigid shoe for 6 weeks. Walking is gradually resumed, with a return to work between 2 and 3 months.

3 Hallux Rigidus

What's it all about?

When osteoarthritis occurs in the first metatarsophalangeal joint, it is called HALLUX RIGIDUS. This is accompanied by stiffness and pain in the big toe, even at rest. It is common to see osteophytes develop. These are bony growths around the affected joint, leading to an increase in joint volume and causing pain from friction when wearing shoes.
This arthrosis may complicate a HALLUX VALGUS deformity.
Depending on the degree of wear, the surgeon may propose a CONSERVATIVE TREATMENT which will preserve the joint while decompressing it by means of osteotomies on either side of the joint space in question. Resection of the osteophytes may be associated.
If the stiffness is too great, the TREATMENT is said RADICAL. In this case, the joint is removed by fusing together the two bones on either side of the joint (METATARSOPHALANGEAL ARTHRODESIS). This gesture does not block the foot per se, but only one of a large number of joints.
Hallux rigidus may occur in the context of an overall deformity of the foot associating hallux valgus, claw toes, flat or hollow foot, etc. Your surgeon may suggest that you combine arthrodesis with other complementary procedures. Shortening of the first ray (big toe) may result in excess length of the little toes, leading to transfer metatarsalgia (pain under the sole). This complication should be prevented by adjuvant osteotomies to set back the lateral metatarsals, which the surgeon suggests on a case-by-case basis.

The medical procedure (arthrodesis)

Arthrodesis involves removing the articular surfaces on either side of the metatarsophalangeal joint and fusing the resulting bony surfaces. Fusion is achieved by compressing the bony surfaces using three or four screws, which are left in place permanently.

Other fixation techniques are available, such as screw-plate fixation. The choice of technique depends on the extent of wear, bone quality and associated deformities.

Big toe prostheses are available. However, these have not proved effective, and their use has gradually been abandoned in France.

Hospitalization

In most cases, you will be hospitalized on an outpatient basis. Conventional hospitalization is also possible if the medical and social context so requires. Anesthesia may be general or locoregional, depending on the patient's condition. The decision is taken with you, during the pre-operative consultation with the anaesthetist.

Once the operation is over, you return to your room after a short period of observation in the recovery room. You will be shown how to walk in the offloading shoe and how to use the cryotherapy bags, which are highly effective against pain and swelling.

You go home (accompanied by a relative or by taxi/ambulance if no one is available to pick you up) with the dressing made in the operating room by your surgeon. This dressing is to keep dry, without changing ituntil around the 18th post-operative day.

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After hospitalization

Your surgeon will dress your wound in the operating room. This dressing must be kept on until the 18th post-operative day.

The support is protected for the first 6 weeks by a shoe with a rigid sole. Wearing this shoe does not require you to associate canes with it, but their use is not forbidden in the event of difficultyś pressing for the first few days. The shoe is prescribed to you as soon as the lʼoperation is scheduled so that you can practice putting it on and wearing it at home the week before the surgery.

In the post-operative period, we recommend alternating walking and elevation. of the operated foot as often as possible (foot on a cushion in bed, foot on a chair in a sitting position, foot in the back seat of a car, etc.). In fact, the sloping position (foot downwards) is responsible for swelling, which can increase pain and make the dressing too tight. Regular pressure on the operated foot is essential, at a rate of 5 to 10 minutes per half-hour. This support not only stimulates the bone for better consolidation, but also reduces the risk of phlebitis and enables you to remain independent, even when climbing stairs.

Anti-coagulant treatment is systematically prescribed for the first 14 post-operative days to prevent phlebitis. Analgesic treatment must be taken as prescribed by your surgeon but can be readjusted according to the lʼévolution of pain.

Driving is not recommended with medical footwear. However, it is possible to change shoes once you are seated behind the wheel, once the dressing has been removed.

From the 6th week, in most cases, full support can be resumed. Resumption of walking will be gradual, as shoeing is not always immediate due to variable edema from patient to patient. You will be offered self-education exercises in association with physiotherapy sessions, particularly for draining purposes.

Resumption of work varies according to the extent of the deformity to be corrected and the type of work you do, usually from the 6th week onwards. Around the 3rd month, when the foot has deflated, you will be prescribed a pair of orthopedic insoles to help the foot regain homogeneous support.

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Possible complications

Foot infection

Foot infection is rare. However, the risk is increased when there are other associated diseases such as diabetes or arteritis. Smoking is also an additional risk factor.

Phlebitis

Phlebitis is prevented by anti-coagulant treatment, and should be detected if calf pain occurs by an ultrasound Doppler test, which your GP or surgeon may prescribe.

Displacement of the arthrodesis or even pseudarthrodesis.

Despite screw fixation, failure to wear the medical shoe or excessive walking can lead to this complication. In the event of significant displacement, the final result may be compromised. In the event of pseudarthrodesis, further surgery may be necessary.

Algodystrophy

This is a condition that can affect any joint following trauma. It manifests as unusual swelling, stiffness and pain. Algodystrophy can prolong the convalescence period by 6 months to 2 years. Its occurrence is relatively rare, and must be prevented by scrupulous analgesic treatment, combined with resting the operated foot according to your surgeon's recommendations.

Paresthesias

These are sensations of electrical discharges in the toes or, on the contrary, a reduction in skin sensation. These phenomena occur in all extremity surgery, as the toes are innervated by very fine terminal nerves, which cannot always be avoided or visualized by the surgeon. In most cases, reinnervation takes place more than 1 year after surgery, and these phenomena fade away, but permanent discomfort may persist.

Edema

The foot remains swollen for several months after surgery, and will tend to swell especially at the end of the day during the first year after surgery. Edema is particularly important if there are underlying venous return disorders (varicose veins). Your surgeon may prescribe draining massages. We recommend that you wear scalloped support socks for the first few months after the foot has been repositioned. The instructions for elevation remain valid even after the foot is walking again.

The appearance of other deformations

Fixation of a hallux varus, especially if it corrects an associated hallux valgus, can lead to the decompensation of other deformities, particularly in the little toes. If this is bothersome, and wearing orthopedic insoles is not enough, your surgeon may suggest additional surgery.

Toe necrosis

This complication, fortunately extremely rare but dramatic, can occur in the little toes when the deformity is very large and long-standing, and the risk is greater in people over 70 or suffering from arteritis. In such cases, surgical correction can lead to ischemia of the toe, leading to necrosis and even amputation.

The death

Any surgical procedure, no matter how minor, can lead to pulmonary embolism or a potentially fatal allergy to anesthetics. This is why your surgeon may decide not to operate on you, despite major deformities, if your state of health does not allow it.

This list of complications is intended to inform you, not frighten you. Your surgeon is a professional who proposes a treatment to treat a disease or deformity. Together with you, he or she weighs up the risks and benefits of the procedure.ʼan intervention and you are always free toʼto accept or refuse it. Post-operative follow-up enables us to detect these complications and offer you appropriate treatment if necessary.

The aesthetic result may sometimes seem disappointing, but theʼThe main objective of this surgery remains functional and analgesic.

Consultation

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Dr. Paul MIELCAREK

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Cabinet

5 Rue de la Coopérative, HALL 1, 67000 Strasbourg, welcomes you Monday to Friday, 8am to 12pm and 2pm to 6pm.

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