Hallux Rigidus Surgery

Hallux rigidus is arthritis of the first metatarsophalangeal (MTP) joint, the joint at the base of the big toe. A bony spur grows on top of the metatarsal head, the toe loses its ability to bend upward, and walking and wearing shoes become painful. It is the second most common problem of this joint after bunions (hallux valgus). About half of patients do well without surgery, using shoe changes, stiff inserts, anti-inflammatory medicine or injections. The operation depends on how worn the joint is. For mild to moderate disease the usual choice is a cheilectomy: through a top or inner incision, the surgeon removes the spur and about a third of the top of the metatarsal head so the toe can bend up again. For severe disease, fusion of the joint (first MTP arthrodesis) is the standard; it has its own setup. For older patients who do not place high demands on the foot, the Keller resection arthroplasty removes the base of the proximal phalanx instead. Joint implants and spacer (interposition) procedures are other options that keep the joint moving. The setup is a small foot case with a thigh tourniquet, a minor orthopedic tray, small osteotomes and power for the drill and saw. Many patients walk in a surgical shoe right after a cheilectomy. A cheilectomy does not stop the arthritis from getting worse, and some patients later need a fusion. After a Keller, the toe can drift upward (cock-up toe), push-off can be weaker, and pain can move to the other metatarsal heads.