Traitement de l'hallux rigidus
The medical treatment
At the initial stage of rigid hallux, medical treatment is necessary. Surgical treatment occurs as late as possible.
It involves symptomatic treatment (anti-inflammatory, frosting, etc.) combined with “mechanical” measures. These measures include in the first place the wearing of wide and flat shoes with rigid soles. This helps to reduce joint stress, and to limit back conflict with the shoes.
We can also prescribe orthopaedicsoles with an anterior bearing bar (to facilitate the natural way of walking). we can still practice an anti-inflammatory infiltration (corticosteroids), or hyaluronic acid (natural lubricant of the joint), all in order to repel to the maximum the surgical gesture
The surgical treatment
At a more advanced stage of the Hallux Rigidus, which resists to medical treatment, a surgical treatment is discussed. No surgical treatment will restore a normal joint… However, pain can be eliminated, completely or partially, joint mobility can be improved, or back conflict can be eliminated…
The procedure takes place under loco-regional anaesthesia, in ambulatory for a pruning, and one night of hospitalization for arthrodesis.
Three cases can be distinguished:
1 – Patient hindered only by the back conflict and not by his joint.
A “pruning” (cleaning or “cheïlectomy”) of the joint is then used to remove osteophytes. This indication is all the more justified if it is impossible to perform osteotomy cable of limiting osteo-arthritic progression, and/or in an elderly or fragile patient. Pruning is of course also practised in other techniques. It should be noticed that even though the conflict has been removed, osteoarthritis is still present. This may explain the persistence of variable but often tolerable painful phenomena.
2 – Patient who is especially bothered by joint pain with a destroyed joint.
In this case, a definitive blockage of this joint (or arthrodesis) is realized. The head of the 1st metatarsal and the base of the 1st phalange are sharpened to obtain bone contact. This contact will allow a fusion of the joint, as for the consolidation of a fracture. The assembly is secured by means of hardware (screws alone, or with plate, etc.). The joint will be blocked in the “heel-boot” position, allowing 4 cm of heel. In the long term, the intervention makes it possible to obtain joint fusion (with loss of mobility), but especially complete indolence.
3 – Patient embarrassed by joint pain and stiffness with partially respected joint (specified by an MRI).
We can perform one of the techniques of «relaxation» joint whose principle is based on the reduction of the intra-articular pressure. A shortening osteotomy (bone section) of the 1st metatarsal and/or 1st phalange is then performed. These techniques help to halt osteoarthritic development, limit pain and improve mobility.
1 – After simple pruning.
Support is allowed quickly with a loose shoe. The work stoppage is of the order of 1 month, the resumption of sports activities from 45 days. The patient may still have painful symptoms related to osteoarthritis, as has been stated. This does not prevent the completion of the final secondary blocking, always possible if necessary.
2 – After arthrodesis of big toe.
The wearing of a shoe with posterior support is necessary for six weeks to 2 months to promote joint fusion. There is no specific rehabilitation prescribed, the purpose being to block the joint. The work stoppage is about 2 to 3 months. We find a usual shoe after 3 months on average (preferably rather rigid initially). In the longer term, arthrodesis allows a quasi-normal activity thanks to the respect of the interphalangial joint of the big toe which, forced, allows a hyperextension. Thus it does not hinder the walk, only the race can sometimes find itself limited. Arthrodesis also prohibits the wearing of high heels.
3 – After shortening osteotomies of the first radius.
The post-operative suites are comparable to those described in the chapter «Hallux valgus».
For the most part: three weeks of specific footwear with posterior support, work stoppage of six weeks to 2 months. Rehabilitation very useful and started as soon as possible to preserve the gains of joint amplitudes, sports and usual shoe wearing from 3 months.