The Use of Osteotomy in the Management of Hallux Rigidus

Metatarsus elevatus and gastrocnemius tightness contribute to the development of functional hallux rigidus. Although several osteotomies have been described for functional hallux rigidus, certain osteotomies are commonly used in practice for the correction of functional hallux rigidus, a long first metatarsal or an elevated metatarsal, or an unstable tarsometatarsal joint. Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint. In the presence of arthritis at the metatarsophalangeal joint, the decision is between an oblique distal metatarsal osteotomy and the shortening periarticular osteotomy.

Functional hallux rigidus and the Achilles-calcaneus-plantar system

Functional hallux rigidus is a clinical condition in which the mobility of the first metatarsophalangeal joint is normal under non-weight-bearing conditions, but its dorsiflexion is blocked when first metatarsal is made to support weight. In mechanical terms, functional hallux rigidus implies a pattern of interfacial contact through rolling, whereas in a normal joint contact by gliding is established. Patients with functional hallux rigidus should only be operated on if the pain or disability makes it necessary. Gastrocnemius release is a beneficial procedure in most patients.