Dr Ling 02 9650 4782       Dr Lunz 02 9650 4835
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  • Dr Jeff Ling - Sydney Foot & Ankle Surgeon
  • Foot & Ankle Surgeon Sydney
  • Dr David Lunz - Foot & Ankle Surgeon

Hallux Rigidus

Dr Jeff Ling & Dr David Lunz


Sydney Orthopaedic Specialists: Foot & Ankle Institute

Hallux rigidus or osteoarthritis of the 1st metatarsophalangeal joint or MTPJ (joint at the base of the big toe) is a common condition. The symptoms are pain and stiffness in the toe. Patients also have difficulty getting up on their toe, running and wearing a high-heeled shoe. Most patients notice a bump on the top of the foot at the 1st MTPJ and a stiff and painful toe. The non-operative treatment for hallux rigidus involves shoe modification, which includes a MBT style (“rocker bottom”) shoe, custom orthotics or sometimes injections. When these measures are no longer satisfactory, surgery is offered.

There are two types of procedures we do for hallux rigidus. The first procedure is called a Moberg-cheilectomy. In this procedure, we first do a cheilectomy (“cheilus” means “lip” in Greek), which involves shaving off the spur on the top of the 1st MTPJ. This spur often blocks dorsiflexion (upwards movement) of the toe. The second part of the procedure is to wedge the toe a little bit upwards so that it bends more. This involves taking a small wedge out of the first bone of the big toe, the proximal phalanx, and inserting a small screw. This procedure is very effective for mild to moderate hallux rigidus and most patients can return to full activity afterwards.

The other procedure we do for hallux rigidus is arthrodesis or “fusion” of the 1st MTPJ. This procedure is for patients with advanced arthritis in the joint who are not suitable for a Moberg-cheilectomy, and patients who may have had other types of surgeries that have failed. This is a very effective treatment for relieving pain, and it is widely considered the gold standard of treatment and patients are generally extremely satisfied after this procedure. They are able to wear normal shoes but are not able to wear more than a two-inch heel. They are able to walk because the joints both downstream and upstream of the joint are still able to bend and compensate for the loss of movement. They are still able to run and play sport, and indeed, there are elite athletes who have had this procedure, who have returned to world-beating form after having had this treatment!

Joint replacement has been tried for some decades in this joint but the results have been very poor. A recent study compared joint replacement to fusion and showed that even patients who had a successful joint replacement still had lower functional scores than patients with a fusion. Furthermore, the complication rate from replacement of this joint is unacceptably high, and until this technique is perfected, we do not offer replacement as an option.

Images

Hallux Rigidus Surgery Sydney

Moberg-cheilectomy for Hallux Rigidus

Hallux Rigidus Surgery Sydney

Arthrodesis (Fusion) of 1st MTPJ

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Patients should discuss their particular situation with the doctors of Sydney Orthopaedic Specialists: Foot & Ankle Institute.