Congenital hallux varus had been a well-described condition for many years before acquired hallux varus as a condition arising from bunion correction was not described until 1935. In that year, McBride discussed this potential problem when describing this as a potential problem from his described technique, identifying possible mechanisms to prevent the disorder from occurring. Authors such as Joplin and Kelikian echoed the concept in the early 1960's, spawning a series of corrective procedures. Miller brought this to common practice in 1975, describing the tendon imbalance seen across the precarious 1. st. MTP joint. The first metatarsophalangeal joint moves in the sagittal plane, dorsiflexion and plantarflexion only. Four intrinsic muscles stabilize the digit, with the abductor and adductor hallucis taking the lion share of this function. The abductor tendon actually functions primarily as a plantarflexor of the first metatarsophalangeal joint 83% of the time (Thompson) due to its primary plantar location. This fact, in combination with the pronation generally seen in severe bunion deformities, contributes to acquired hallux varus following bunion correction. Besides the obvious cause of over-correction of the metatarsal osteotomy creating hallux varus, imbalance of the tendon complex post-operatively can create an equally catastrophic circumstance. Hawkins demonstrated that severing the adductor tendon complex (the conjoined tendon) will not product hallux varus when the hallux is not rotated. However, in more severe hallux valgus, pronation of the hallux may be proportional to the deformity of the hallux itself. This rotational deformity places the insertions of the abductor (and medial insertion of the flexor brevis) more plantarward and lateral, increasing the valgus deformity. If the entire conjoined tendon is sectioned and the internal rotation deformity corrected the insertion of the contracted abductor moves medially, pulling the toe into varus. If the center of the base of the proximal phalanx is brought beyond the mid-point of the first metatarsal head, the extensor hallucis longus will bowstring, pulling the great toe into varus while creating a hallux flexus deformity. Finally, if the lesser toes are in varus and not corrected, this deforming force will create hallux varus following bunion correction with a lateral release. The message is clear: not all patients require a lateral release, and, if done, should be done with caution. Once present, correction can be difficult. Tendon transfers utilizing the extensor hallucis longus (Johnson) or extensor hallucis brevis (Myerson) only have beneficial effects in non-arthritic, mobile first metatarsophalangeal joints. In addition, if metatarsal deformity is not corrected, the deformity will recur. Thus, in many circumstances, arthrodesis of the first metatarsophalangeal joint becomes the treatment of choice, and is commensurate with a disappointed patient who underwent a primary bunion correction and was left with a fused great toe. This lecture will explore the above mechanism and salvage situations, in hopes of eliminating this unwelcomed outcome from your practice

Objectives. Cartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As for now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants. Study design and methods. Patients at a single centre with symptomatic hallux rigidus who underwent Cartiva SCI implant procedure were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ). Results. 66 patients (19M, 47F) (43R and 23L) were followed up for an average of 14 months (min=2, max=36). 17 patients suffered from HJ2/moderate arthritis and 49 patients with grade HJ3/severe arthritis. Post-operative mean FAAM scores showed statistically significant improvement (p< 0.0001). Patients reported a 40% increase in functionality during activities of daily living. All 3 MOXFQ Domain scores improved significantly (p< 0.02). The Index score improved by 28 points (p< 0.0001). There was no correlation between length of follow up or age and PROMs (r=0.129). No statistical difference was demonstrated between sexes. However clinically, males and older patients exhibit better outcomes. There was a 89.4% patient satisfaction with the use of Cartiva. Conclusions. Our study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Pain in particular was significantly reduced. One third of patients developed post-operative stiffness requiring a manipulation under anaesthesia. Patient selection is key. Additional imaging may be required to assess sesamoid osteoarthritis. At 3 years the implant has demonstrated to be safe and efficacious in the management of hallux rigidus. Durability and survivability of the implant will continue to be studied in this cohort

Purpose: Constitutional factors responsible for hallux falgus and hallux rigidus remain unclear. The purpose of this work was to compare the radiological feature of the forefoot in three populations with “normal” feet, hallux rigidis, and hallux valgus. Material and methods: One standard protocol was used within the same unit to obtain dorsoplantar AP views of the foot in the standing position in all subjects. Fifty “normal” feet, with no apparent deformation, callosity, or pain, were selected among the orthopaedic unit personnel; mean age of the 25 subjects was 30.3±9.6 years, and 44% were women. The 30 patients with hallux rigidus were operated on at a mean age of 57.4±10.7 years, and 48.4% were women. The 50 patients with hallux valgus were operated on at a mean age of 50.8±12.8 year and 92% were women. All radiograms were digitalised (Vidar VXR-12 plus) and analysed by four observers using the FootLog software which provides semiautomatic measurements. The following parameters were recorded: distance between the lateral sesamoid and the second metatarsal (LS-M2), the M1P1 angle (for the diaphyseal and mechanical axes of M1), the diaphyseal and mechanical distal metatarsal articular angle (DMAA) of M1, Meschan’s angle (M1–M2–M5), the distance between a line perpendicular to the axis of the foot drawn through the centre of the lateral sesamoid and the centre of the head of M4 (MS4–M4) (a corrective factor was introduced for the MS4–M4 distance to account for the displacement of the lateral sesamoid in hallux valgus), the M1 index = d1-D2 (length of the head of M1/MS4 – length of the head of M2/MS4), maestro 1 = d2–d3, maestro 2 = d3–d4, maestro 3 = d4–d5. The measured parameters were recorded automatically on an Excel data sheet and statistical analysis was performed with SPSS 9.0. Results and discussion: Intra- and inter-observer reproducibility of measurements and morphological classifications were excellent. The LS/M2 distance was comparable in the three populations, proving that the lateral sesamoid is relatively fixed compared with the M2 and enabling its use as reference for the MS4 line. The Meschan angle did not discriminate between the three populations, likewise for the mean M1/M2 index, the M1P1, M1M2, and DMAA angles which were different in the three populations; there were 2° to 3° variations for the mechanical or shaft axis. The morphotype analysis demonstrated objective evidence of morphological differences of the forefoot in the three populations. The hallux rigidus group showed a predominance of the index plus and plus-minus with long M23 lateral patterns, while the hallux valgus group exhibited a predominance of M4M5 hypoplasia. Discussion: Morphotypic definition of the metatarsals is an interesting approach providing a measurable way of interpreting forefoot disorders and guide surgical correction. These results should be confirmed with measures in larger series, which can be accomplished with FootLog software. It would also be useful to combine radiological studies with baropodometric studies

Background. Surgical intervention for hallux valgus and hallux rigidus is an option for patients presenting with severe pain and deformity. Literature suggest that patients with high Pain Catastrophisation Scores (PCS) have poorer outcomes in spinal and to a lesser extent in arthroplasty surgery. There is however very little evidence pertaining to foot and ankle surgery. Aim. We aimed to study whether catastrophisation as measured by PCS influenced the outcomes following surgery for Hallux valgus and rigidus. Methodology. Ethical approval for this prospective portfolio study was obtained from NRES Committee South Central and Oxford. Approval was granted from the local R&D department prior to data collection. All patients listed for surgery for hallux pathology to the four senior authors were invited to participate. Recruitment into the study started in September 2017 and is ongoing. Pain catastrophising score (PCS), Manchester Oxford Foot Questionnaire (Mox-FQ), Visual analog scale (VAS) for pain and EQ-5D-3L questionnaires were completed Pre-op (baseline), and at 3, 6 and 12- months post-surgery. Results. 93 patients with minimum follow-up of 6 months were analysed using SPSS software. A P-value of less than 0.05 was considered significant. The mean age of the patients was 58.5 years and 83% were women. 70% of the patients had surgery for hallux valgus and rest for rigidus. Both PROMS and PCS improved significantly following surgical intervention. Patients with higher pre-operative PCS had a worse 6-month PROM score and more pain. Conclusion. This study confirms that pre-operative catastrophisation as demonstrated by a high PCS score has an adverse effect on outcomes following hallux surgery. Risk stratifying patients based on their Pre-op PCS scores may be a useful strategy to identify those at risk of poorer outcomes. We recommend that behavioural change interventions should be considered to try to improve outcomes in patients with pre-op PCS

Background. Iatrogenic hallux varus is a rare complication after hallux valgus surgery. Operative treatment comprises a wide variety of techniques, of which the reversed transfer of the abductor hallucis tendon is the most recent described technique. Methods. This paper will present the long-term clinical results of the reversed transfer of the abductor hallucis longus. Therefore, we performed a prospective clinical observational study on 16 female patients. Our hypothesis is that the tendon transfer will persist in a good alignment and patient satisfaction on long term. There is a 100% follow-up rate with a range from 10 to 101 months. Patients were subjected to a clinical examination, three questionnaires and their general satisfaction. Results. Out of 16 patients, at time of follow-up, we found a positive correlation between the subjective outcome score and alignment (r = 0.59), and between the general satisfaction and alignment (r = 0.77). Based on the general satisfaction we achieved a success satisfaction rate of 69% (11 patients). The other 31% (5 patients) patient group was only satisfied with major reservations or not satisfied at all. The two most invalidating complications were a coronal or sagittal malalignment or the combination of both. Conclusion. Our results suggest that the reverse abductor hallucis tendon transfer is a good technique to treat a supple iatrogenic hallux varus with an observed success satisfaction rate of 69% at a mean follow-up time of 48 (range 10–101) months. However, patients should be informed that on the long-term loss of correction is possible

Background. Severe hallux rigidus can be treated with total or hemi arthroplasty to preserve motion in the 1st metatarsophalangeal joint (MTPJ). Decreased dorsiflexion impairs the rollover motion of the 1st MTPJ and recent studies of patients with 1st MTPJ osteoarthritis show increased plantar forces on the hallux. Objectives. Our aim was to examine the plantar force variables under the hallux and the 1st, 2nd, and 3rd – 5th distal metatarsal head (MH) on patients operated with a proximal hemiarthroplasty (HemiCap) in the 1st MTPJ and compare to a control group of healthy patients. Secondary aims: To examine correlations between the force and the 1st MTPJ range of motion (ROM) and pain. Study Design & Methods. Seventy patients operated with HemiCap were invited. 41 were included, (10 men, 31 women), median operation date 2011(range 2007–2014), age 63(47–78), 37 unilateral and 4 bilateral. Dorsal ROM of the 1st MTPJ was measured by goniometer and by x-ray. Pain evaluated by visual analog scale (VAS 1–10) during daily activities (DA) and during testing (DT). Emed (Novel) Foot Pressure Mapping system was used to measure peak force (N) and force/time integral (N/s) under the hallux, 1st and 2nd and 3–5th metatarsal heads (MH). Statistics: Force variables between operated feet and control group were compared by independent two-sample t-test or Wilcoxon rank sum test. Force variables association to ROM and pain by linear regression models. Results. Median (range) for HemiCap/Control group: Peak force (N): Hallux: 12(1–26)/20(4–30), 1st MH: 17(8–41)/24(14–42), 2nd MH 24(15–37)/28(24–37), 3rd–5th MH: 27(18–36)/30(25–35). Force/time integral (N/s): Hallux: 1(1–4)/4(1–12), 1st MH: 5(2–18)/7(3–11), 2nd MH 8(4–13)/10(7–13), 3rd–5th MH: 9(6–15)/10(8–14). Significant difference between HemiCap patients and healthy controls in peak force and force/time integral was found under the hallux (p<0.01), 1st (p<0.05) and 2nd MH (p<0.05), and max force under the 3–5th MH (p<0.01). Dorsal ROM of the operated feet was 45 degrees (10–75) by goniometer and 41 degrees (16–70) by x-ray. An increase in dorsal ROM decreased the peak force and force/time integral under the hallux (p>0.05) but not under the MHs. Most patients reported no pain (VAS 1: 62% DA, 78% DT), only 2 patients reported VAS>3. No significant correlation between pain and force or force/time integral. Conclusions. A mid-term hemiarthroplasty do not restore the joint motion to normal. The loading patterns are in opposition to AO patients as as assfgjkdfgjkfdgjk the HemiCap patients show a significantly decreased peak force and force/time integral under the hallux compared to the control group and the larger the dorsiflexion achieved postoperatively the smaller the force/time integral becomes. It may reflect a patient reluctance to load the 1st ray and 2nd MH. The plantar forces are not linked to pain. Most report minimal pain, but the pain score is biased by missing numbers and exclusion of revisions

Introduction and purpose: The expression hallux rigidus is used to describe a situation characterized by pain and a decrease in range of movement of the first metatarsophalangeal joint: the head of the first metatarsal moves on a sagittal plane without a stable surface, in spite of stabilizers such as the phalanx itself and the gleno-sesamoid system. The aim of this retrospective study is to define demographic data and their association with etiological, clinical and radiological factors in patients with primary hallux rigidus. Materials and methods: We reviewed the records of one hundred and forty patients operated in our department between 1995 and 2005 for hallux rigidus. We selected 66 cases of primary hallux rigidus with complete clinical records. We excluded all secondary hallux rigidus cases from the study. Results: We carried out comparative ANOVA studies to validate the relationship between weight and degree of hallux rigidus, as well as the relationship with BMI (body mass index), the value of the hallux valgus and distal hallux angle, the value of the adductor and the intermetatarsal angle. All these data were studied for a confidence interval of 95% and 90%. No statistically significant relationship was found, which does not mean that there may not be a relationship between parameters. Moreover, a direct relation was found between gender and development of hallux rigidus (p=0.095), which is statistically significant for a confidence interval of 90%. Height is also a parameter related to hallux rigidus, the greater the height of the patient the greater the development of hallux rigidus (p=0.067) for a 90% confidence interval. A radiological parameter statistically related to hallux rigidus is the elevation of the first metatarsal (p=0.075) for a confidence interval of 90%. Conclusions:. Female sex and a greater frequency of hallux rigidus have a statistically significant relationship (p=0.095) for a 90% confidence interval. This is contrary to the opinion expressed in most of the literature published up to the present. The height of the patient and a greater frequency of hallux rigidus seem to have a statistically significant relationship for a 90% confidence interval (p=0.067). This has not been mentioned up to now in any published paper. The metatarsus primus elevatus is the only anatomical-radiological factor that we found, in our study, to have a statistically significant relationship with the appearance of hallux rigidus (p=0.075) for a 90% confidence interval. For factors such as hypermobility of the 1. st. toe, excess of the 1st axis, adductor metatarsus, interphalangeal hallux valgus and chevron shaped joint, we have found no significant relationship with the development of hallux rigidus

Background. Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief but sacrifices ROM. Recently the Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is largely based on a single cohort with mixed outcomes. We sought to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. Methods. Retrospective review of patients undergoing Cartiva SCI or arthrodesis for treating hallux rigidus was conducted. Preoperative arthritis was radiographically graded using the Vanore classification. Patient reported outcomes (PROMs) were assessed using EuroQol 5-dimension score (EQ-5D-5L) and Manchester-Oxford Foot Questionnaire (MOXFQ). Results. Between 2017 and 2020 there were 33 cases (17 Cartiva, 16 arthrodesis, mean age 59.0±9.9 years) with a mean follow up of 2.3 years. For the first MTPJ arthrodesis cohort, the MOXFQ domain scores were: Index 3.9±5.8, Walking/Standing 5.1±7.6, Pain 3.2±5.0, and Social Interaction 2.6±4.0. EQ-5D-5L Index score was 0.828±0.270 and the EQ-VAS was 72.5±23.3. For the Cartiva cohort, the MOXFQ domain scores were: Index 7.7±6.0, Walking/Standing 8.9±7.9, Pain 7.1±5.0, and Social Interaction 6.4±5.4. EQ-5D-5L Index score was 0.631±0.234 and the EQ-VAS was 74.8±20.8. There was no statistically significant difference between any MOXFQ domain or EQ-5D-5L scores. However, a negative trend in MOXFQ domains was identified for the Cartiva group, as well as a reoperation rate of 23.5%. Conclusions. The Cartiva SCI demonstrated no advantage over arthrodesis in PROMs, despite the presumed benefit of preserved ROM. A significant reoperation rate was also observed. Surgeons should be cautious in the use of this novel implant

Introduction. Cheilectomy is a recommended procedure for the earlier stages of osteoarthritis of the 1. st. metatarsophalangeal joint. Although good improvement in symptoms have been reported in many studies, the long term performance of this procedure is not well understood. It is thought that a significant number of patients go onto have arthrodesis or joint replacement. We report on a large cohort of patients who received this procedure and report on the complications and mid-term outcome. Methods. This is a retrospective study looking at all patients who underwent cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to access patient details and outcome measures recorded include: postoperative wound infection, patient reported improvement in pain and the incidence of further surgical interventions like revision cheilectomy and conversion to arthrodesis and arthroplasty. X-rays were studied using PACS to stage the osteoarthritis (Hattrup and Johnson classification). Results. A total of 240 feet in 220 patients (20 bilateral surgeries) were included in the study, there were 164 Females (75%) and 56 Males (25%), the median age was 55 years (range 22–90 years). Radiological assessment showed 89 Stage 1 arthritis(42%), 105 Stage 2 (50%), 17 Stage 3 (8%) and 9 patients were excluded due to unavailable X-rays. 5 patients (2%) had superficial wound infection. There were 16 further surgeries (7%) performed in this cohort, 12 arthrodesis (5%), 3 revision cheilectomy and 1conversion to arthroplasty. 157 patients were found to be pain-free at the latest post-operative visit (77%), 48 reported minimal pain (23%), 15 patients were excluded due to unavailable data. Conclusion. Cheilectomy appears to produce good improvement in pain with a low complication rate. The rate of conversion to arthrodesis/arthroplasty is lower than in many reported studies

In most cases the etiology of Hallux rigidus is unknown. The purpose of this presentation is to discuss the classification of hallux rigidus, as well as the treatment options for every stage. Treatment suggestions should be individualised depending not only on the grade of the hallux rigidus, but also the patient's expectations. These include expectations regarding footwear, recreational activities and the potential of further surgeries depending upon the initial choice of treatment. Emphasis will be placed on joint preserving options, including adding a Moberg osteotomy to proximal halangs to increase perceived dorsiflexion of the great toe

Purpose of study:. Congenital hallux varus is a rare condition presenting with medial deviation of the big toe. It consists of 2 variants: classical congenital hallux varus caused by an abnormal metatarsal-phalangeal articulation, and a more recently described variant due to a “bracket physis” of the first metatarsal. Our aim was to perform an audit of the spectrum of presentation of congenital hallux varus with its management and complications in our unit over a five year period. Description of methods:. A retrospective review of congenital hallux varus treated by a single surgeon was performed. Clinical notes, photographs and x-rays were reviewed. Two surgical methods of treatment were used as directed by clinical and radiological findings. Summary of results:. Four patients with congenital hallux varus were identified. Three had bilateral involvement, i.e. seven feet were treated. The ages of the patients ranged from 1 to 9 years, with 2 boys and 2 girls receiving treatment. In two patients (4 feet) the deformity was associated with pre-axial polydactyly. One patient had associated hand deformities. Only one of our four patients had a “bracket physis” and was treated with a metatarsal osteotomy. The other three patients (6 feet) were treated by soft tissue realignment using the Farmer procedure. One patient who had bilateral Farmer procedures subsequently developed a bunion over the 1st metatarso-phalangeal joint of one foot due to uncovering of the metatarsal head. No complications or recurrences were recorded in the other three patients on follow up visits. Conclusion:. Careful clinical and X-ray analysis is important to determine the type of congenital hallux varus and which method of surgical treatment is appropriate. Long term follow up is required to identify subsequent deformities

Cheilectomy is a recommended procedure for early stage osteoarthritis of the 1st metatarsophalangeal joint. Although improvement in symptoms has been reported in many studies, long term performance is not well understood. It is thought that significant numbers of patients require subsequent arthrodesis or arthroplasty. We report on a large cohort of patients receiving this procedure and on complications, and mid-term outcome. This is a retrospective study looking at all patients undergoing cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to record outcome measures including: postoperative wound infection, patient reported improvement in pain and incidence of further surgical interventions like revision cheilectomy, conversion to arthrodesis and arthroplasty. Osteoarthritis was staged radiographically using PACS (Hattrup and Johnson classification). A total of 240 feet in 220 patients (20 bilateral surgeries) were included with 164 females (75%) and 56 males (25%), the median age being 55 years (range 22–90 years). Radiological assessment showed 89 stage 1 arthritis (42%), 105 stage 2 (50%), 17 stage 3 (8%) and 9 patients were excluded due to unavailable radiographs. 5 patients (2%) had superficial wound infections. There were 16 further surgeries (7%); 12 arthrodesis (5%), 3 revision cheilectomy and 1 conversion to arthroplasty. 157 patients were found to be pain-free at the latest post-operative visit (77%), 48 reported minimal pain (23%), 15 patients were excluded due to incomplete data. Cheilectomy appears to effectively reduce pain with low complication rates. Rates of conversion to arthrodesis/arthroplasty are lower than in many reported studies

Hallux varus is a rare cause of pain in the foot mostly occurring after failed hallux valgus surgery. We reviewed 12 patients with unilateral hallux varus treated with soft tissue techniques (4x), arthrodesis of the first metatarso-phalangeal joint (3x) or with a distal chevron osteotomy (5x) with medial transposition of the first metatarsal head and reconstruction of the soft tissues on the lateral side of the metatarsophalangeal joint. 10 patients had previous hallux valgus surgery, in 2 cases the deformities were of unknown origin. 1 male and 11 female patients were followed up on average 26.4 months postoperatively. AOFAS hallux score improved from 46 (range 10–75) to 86 (range 72–95) points. The metatarsophalangeal angle measured with the center-head to center-base method was reduced from −16.1° (range −35° to −8°) to 5.1° (range −15° to 21°). The intermetatarsal angle increased from 5.8° (0–11°) t o 10.5° (0–19°). All patients were subjectively satisfied with the procedure. Our results indicate that joint preserving operation techniques are viable methods in the correction of mild and moderate symptomatic hallux varus deformities. Mild remaining varus deformities are well tolerated. In case of severe varus deformity or major signs of osteoarthritis in the first metatarsophalangeal joint MTP arthrodesis provides good results

Introduction:. Hallux surgery is the most commonly performed elective surgery in the foot and ankle. As with all surgery, there are many potential complications quoted in the literature. Venous thromboembolism (deep vein thrombosis and pulmonary embolism) incidence and prophylaxis, however, is not adequately addressed and remains controversial. Material and Method:. This prospective study includes one hundred patients who underwent hallux surgery. Risk factors implicated to increase the risk of developing venous thromboembolic disease as well as anaesthetic time, thigh tourniquet time and regional anaesthetic blocks were documented. Compressive ultrasonography was performed in all the patients postoperatively to assess for deep vein thrombosis. Results:. There was one incident of calf deep vein thrombosis (DVT). No patient developed a pulmonary embolus. The one patient who developed a DVT was not at any higher risk than the average patient in the study. Conclusion:. As a result of the low incidence of venous thromboembolic disease in this study, the authors do not recommend the routine use of chemical venous thrombo-prophylaxis in patients undergoing hallux surgery. The decision to give postoperative anticoagulation remains the surgeon's responsibility. The duration of prophylaxis will depend on when the patient is fully mobile

Hallux rigidus was first described by Davies-Colley and Cotterill in 1887 and varied management techniques have been described by authors since. This paper carries out an audit looking at the management of hallux rigidus in 108 patients. A retrospective study was carried out on 108 patients coded as hallux rigidus/hallux valgus over a ten year period from 1992 to 2002 (33 male and 75 female) with a follow-up range from 3 to 144 months. Thirty three toes (27 patients) were fused, 20 toes had Tel Aviv procedures (17 patients) and 61 patients were managed conservatively. Of the 33 toes fused, 18 required a second procedure in the form of wire removal, two developed transient transfer metatarsalgia, one developed IP joint pain and one had asymptomatic fibrous non-union. Of the 20 Tel Aviv procedures, one toe developed hallux valgus requiring re-operation and two toes had unrelated complications, one requiring re-operation. A single method of MTP fusion when the audit was performed revealed an interesting outcome. Hallux rigidus must be managed as an ongoing continuum, not a static state

Twenty-two patients who underwent thirty-four Kellers’ excision arthroplasty were followed up at an average of thirty-five months. They were assessed using AFAOS, satisfaction and radiological evaluation. The average hallux score was eighty- five (fifty-two to one hundred) while the average lesser toe score was ninety- two (seventy-five to one hundred). The average pain score was thirty- six (twenty to forty) for the hallux and thirty-eight for the lesser toes (twenty to forty). 23/34(68%) had good to excellent, 6/34 (18%) had fair and 5/34(14%) had poor results. The great toe was moderately short, but most patients do not seem to mind this. 91% patients were satisfied with the results. We undertook a retrospective study of Kellers’ excision arthroplasty done over the last seven years to assess the medium term results. Twenty-two patients who underwent thirty- four Kellers’ excision arthroplasty were followed up at an average of thirty-five months. They were followed up using the AFAOS, patient satisfaction and radiological evaluation. The average age at the time of surgery was 67.4 years. There were seventeen females (twenty-five feet) and five males (nine feet). All patients underwent bunionectomy along with excision of proximal third of the proximal phalanx. Of these twenty underwent K wire stablization of the hallux following excision. The average hallux score was eighty- five (range sixty-two to one hundred) while the average lesser toe score was ninety- two (range seventy-five to one hundred). The average pain score was thirty- six (range twenty to forty) for the hallux and thirty-eight for the lesser toes (twenty to forty). 23/34 (68%) had good to excellent, 6/34 (18%) had fair and 5/34(14%) had poor results. The average correction of the hallux valgus was 9o. The average IMT was 25o preoperatively and 18o postoperatively. The average shortening was 7 mm. Complications included two cases of transfer metatarsalgia and two cases of clawing of the lesser toes. One patient developed abscess which settled after incision and drainage. Thirty-one out of thirty-four patients were satis-fied with the final outcome and thirty out of thirty-four patients would have the operation on the other feet. The great toe is moderately short, but most patients do not seem to mind this. 91% patients were satisfied with the results

Introduction. Studies have compared outcomes of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on outcomes. We evaluated data from a prospective, RCT of MTPJ1 implant hemiarthroplasty (Cartiva) and arthrodesis to determine the association between patient factors and clinical outcomes. Methods. Patients ≥18 years with Coughlin hallux rigidus grade 2, 3, or 4 were treated with implant MTPJ1 hemiarthroplasty or arthrodesis. Pain VAS, Foot and Ankle Ability Measure (FAAM) Sports and ADL, and SF-36 PF scores were obtained preoperatively, and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Final outcomes, MTPJ1 active peak dorsiflexion, secondary procedures, radiographs and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. Composite primary endpoint criteria for clinical success included pain reduction ≥30%, maintenance/improvement in function, and no radiographic complications or secondary surgical intervention at 24 months. Predictor variables included: grade; gender; age; BMI; symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, ROM, and pain. Two-sided Fisher's Exact test was used (p< 0.05). Results. Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus and ROM (p0.05). Conclusion. Synthetic cartilage implant hemiarthroplasty (Cartiva) is an appropriate treatment for patients with hallux rigidus grade 2, 3 or 4 and is a reasonable choice in hallux rigidus in patients with < 20 degrees HVA, with a high degree of preoperative stiffness, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain, or duration of symptoms, in contrast to what might have been expected

Introduction. Arthroplasty for treatment of end stage hallux rigidus is controversial. Arthrodesis remains the gold-standard, but this procedure is not without complications, with up to 10% non-union, 14% re-operation and 10% transfer metatarsalgia rates reported. The aim of this study was to analyse the outcome of the double-stemmed silastic implant (Wright-Medical) for end stage hallux rigidus. Method. We conducted a retrospective review of a consecutive series of 108 silastic 1. st. MTPJ implanted in our Unit (January 2005 – December 2016). Data was collected from our research databases, patient notes, PACS and PROMS. No patient was lost to follow-up. Results. Average age was 60.1 years (range 42–42 years; 104F; 4M). Results show a 98.1% survivorship at an average 5.1 years follow up (range 6 months-12 years). Average pre- and post-operative MOXFQ scores were 78.8/100 and 11.0/100 respectively and VAS scores improved from 7/10 to 1.3/10, with an average post-operative range of movement of 26.3°. Overall satisfaction rate was 90.6%. 2 patients (1.9%) required revision; 1 for early infection (2 months) and 1 for stem breakage (10 years). There were 15 complications (13.9%) in the group, 5 lateral metatarsalgia, 7 patients stiffness and ongoing pain in the index joint occurred in 2.7%. There was a 20% incidence of radiological cyst formation or demarcation, but this was neither progressive, symptomatic, nor affected clinical outcome. Conclusions. The authors believe these results are superior to results of other published implants for hallux rigidus (BioPro and Cartiva). Additionally, these results do not confirm progressive osteolysis, previously reported for this implant in other series, as being a mechanism of failure. Finally, these results suggest the double stemmed silastic 1. st. MTPJ replacement provides a reliable alternative, with at least comparable outcomes, to that of fusion, for the treatment of end stage hallux rigidus

Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results. All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results. Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf. We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus

Introduction: We present 34 patients diagnosed with hallux rigidus treated by percutaneous surgery. We analyzed the surgical techniques used and the functional results achieved. Materials and methods: We retrospectively collected 34 patients (24 women). Patients were stratified by means of parametric x-rays (Hanft classification from 1 to 4). Treatment consisted in a double osteotomy, also known as Keller’s technique, using percutaneous procedures. The postoperative protocol consisted of walking, use of orthopedic footware, and early mobilization. Results: Mean age was 68.78 years and mean follow-up was 31.45 months. Mean time from first clinical visit to surgery was 4.38 years; most patients had received conservative treatment. The mean degree of hallux rigidus according to the standard classification was 2.5. The mean value of the metacarpophalangeal joint arc and interphalangeal joint arc was 40.35°and 52.14° respectively. Return to work activities was achieved in 90.9%. The mean value according on the VAS (visual analogue scale) (0–10) was 3.14. The mean value on the AOFAS scale was 62.57 (0–100). Conclusions: Percutaneous surgery is a satisfactory method for the treatment of hallux rigidus, enabling the patient to quickly return to work. This procedure avoids the use of osteosynthesis materials and minimizes the complications seen in open surgery