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Hallux limitus is really conglomeration of multiple
conditions which involves the 1st metatarsophalangeal joint:
- 1st MPJ impingement 2` met primus elevation
- 1st MPJ
impingement 2` long 1st metatarsal
- 1st MPJ synovitis
- 1st MPJ chondromalacia
- early 1st MPJ DJD
As a result
treatment options have become extremely more complicated and varied. The days of simply performing a cheilectomy are gone.
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Typical hallux limitus case. There is no signs of osteophytes. There is no definitive history
of injury. There is simply pain with 1st MPJ ROM. There is less then 60 degrees of dorsiflexion.
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As with many cases, there is an elevated 1st metatarsal. There is no signs of hypermobility.
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Performed a 1st MPJ scope to assess the joint. The lateral gutter of the joint was filled with
synovitis.
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To our suprize, a full thickness flap of cartilage on the central portion of the 1st metatarsal
head
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After debridement, left with a full thickness loss
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Performed a proximal chevron osteotomy with the chevron being made dorsally and the metatarsal
being translated plantarly
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Similar type of case and presentation as the last
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Performed an 1st MPJ arthrodiastasis using an Orthofix rail and plantarflexory osteotomy
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Plantarflexory osteotomy performed by making three saw passes through the osteotomy site at an
angle to accomodate a screw and to reduce the shortening
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1st MPJ arthroscopy may take longer to do, but the
downside for the patient is quicker recovery and improved 1st MPJ ROM
Arthrodiastasis is an excellent option for cases
that really can't afford to lose length. When used in conjunction with a 1st MPJ scope, arthrodiastasis tends to have a greater
success then just stretching the joint.
Also see www.smalljointscope.com for more on 1st MPJ arthroscopy and see www.footex-fix.com
for more on arthrodiastasis.
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