Surgical management of hallux limitus and rigidus in the young patient.
As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.
DeLauro
T M
TM
New York College of Podiatric Medicine, New York.
Positano
R G
RG
D000328:Adult; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000601:surgery; D010003:Osteoarthritis / Q000601:surgery*; D010027:Osteotomy; D014033:Toe Joint / Q000601:surgery