With progression of the disease process, one will note further proliferation of reactive bone along the dorsal aspect of the joint and degeneration of the dorsal articular surface. If the symptoms are of sufficient magnitude to limit the athlete’s activities, you should consider surgical intervention. There is an array of surgical procedures for treating hallux rigidus. Each procedure can be classified according to the specific area of the MTPJ. Surgery consists of five categories: • remodeling arthroplasty • resection arthroplasty • arthrodesis • replacement arthroplasty • periarticular osteotomy When performing surgery on these athletes, one seeks to increase range of motion, maintain the length of the toe and reduce symptoms. Cheilectomy procedures are often indicated, with resection of at least one-third of the dorsal aspect of the metatarsal head, any osteophytes present at the base of the proximal phalanx and loose bodies. One should avoid implant arthroplasties and fusions in this patient population. Final Notes Although hallux rigidus is a progressive disorder, prophylactic taping of the hallux and modifications to the shoe to stiffen the sole will decrease the repetitive stress placed on the great toe. In addition, you should emphasize exercises to increase dorsiflexion in the athlete who has limited motion of the first MTPJ. Dr. Caselli is an Adjunct Professor in the Department of Orthopedic Services at the New York College of Podiatric Medicine. He is also a staff podiatrist at the VA Hudson Valley Health Care System.
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