Our Summary

This research paper looks at two procedures used to treat hallux rigidus, a condition that causes stiffness and pain in the big toe. The first procedure, cheilectomy, is often the go-to option for early-stage treatment. It involves removing bone spurs to improve joint movement. Recent studies show that this method can also be effective for more severe cases. But when the condition is too advanced, the best strategy is usually first metatarsophalangeal (MTP) fusion, a surgery to join the bones in the big toe. It’s common for doctors to try cheilectomy first, saving joint fusion as a backup if the first method doesn’t work. This article reviews the research on the impact of having a cheilectomy before a first MTP joint fusion.

FAQs

  1. What is the first-line choice for treating early stages of hallux rigidus?
  2. When is the first metatarsophalangeal (MTP) fusion considered as the most appropriate strategy for hallux rigidus treatment?
  3. How does a prior cheilectomy potentially affect a subsequent first MTP joint arthrodesis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about joint fusion is to follow a comprehensive rehabilitation program after surgery to promote proper healing and optimal joint function. This may include physical therapy, exercises to improve range of motion and strength, and guidance on gradually returning to normal activities. It is important for patients to communicate any concerns or difficulties they may have during the recovery process to their healthcare provider to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for joint fusion include those who have advanced stages of hallux rigidus and have not seen improvement with conservative treatments such as cheilectomy. Patients with severe degeneration of the joint, significant pain, and limited range of motion may benefit from first metatarsophalangeal (MTP) fusion as a more definitive treatment option. Additionally, patients who have undergone a cheilectomy but continue to experience symptoms may also be recommended for joint fusion as a secondary treatment option.

Timeline

Before joint fusion:

  1. Patient presents with symptoms of hallux rigidus, such as pain, stiffness, and limited range of motion in the big toe joint.
  2. Initial evaluation and diagnosis by a healthcare provider, which may include physical examination, imaging studies (such as X-rays), and possibly conservative treatments like medication, orthotics, or physical therapy.
  3. If conservative treatments fail to provide relief, the patient may be considered a candidate for surgical intervention.
  4. Cheilectomy may be performed as a joint-preserving procedure to remove bone spurs and improve joint function in the early stages of hallux rigidus.
  5. If the patient’s condition progresses or if cheilectomy is unsuccessful, first metatarsophalangeal (MTP) fusion may be recommended as a more definitive treatment option.

After joint fusion:

  1. The patient undergoes first MTP joint fusion surgery, where the bones of the big toe joint are permanently fused together to eliminate motion and reduce pain.
  2. Post-operative recovery period, which may include immobilization in a cast or boot, physical therapy, and gradual return to weight-bearing activities.
  3. Follow-up appointments with the surgeon to monitor healing and assess the success of the fusion.
  4. Long-term management of the fused joint, which may involve adaptations in footwear and activity level to prevent complications and maximize function.
  5. Overall improvement in pain and function of the big toe joint, with the goal of returning the patient to their desired level of activity and quality of life.

What to Ask Your Doctor

  1. What is the success rate of joint fusion compared to other treatment options for hallux rigidus?
  2. What are the potential risks and complications associated with joint fusion surgery?
  3. How long is the recovery period after joint fusion surgery?
  4. Will I have limited range of motion in my joint after fusion surgery?
  5. Will I be able to participate in physical activities or sports after joint fusion surgery?
  6. How likely is it that I will need additional surgeries or treatments after joint fusion?
  7. What is the expected lifespan of the joint fusion surgery?
  8. How will joint fusion surgery affect my daily activities and quality of life?
  9. Are there any alternative treatments or therapies that I should consider before proceeding with joint fusion surgery?
  10. What is the long-term prognosis for patients who undergo joint fusion surgery for hallux rigidus?

Reference

Authors: Mizher R, Rajan L, Ellis SJ. Journal: Foot Ankle Clin. 2024 Sep;29(3):529-540. doi: 10.1016/j.fcl.2023.10.005. Epub 2023 Nov 8. PMID: 39068027