Summary

The purpose of this study was to assess the outcome of hybrid technique in patients with diagnosis of Hallux rigidus

Abstract

Background

Arthritis of the first metatarsophalangeal joint, hallux rigid, is a common and disabling source of foot pain in adult populations. Hallux rigidus is characterized by diseased cartilage and large periarticular osteophytes that results in a stiff, painful joint. A number of surgical options exist for the treatment of recalcitrant hallux rigidus (dorsal cheilectomy, dorsal wedge osteotomy, arthroplasty even arthrodesis). As arthroscopic techniques and a instruments have improved for small joints, arthroscopic techniques to address hallux MTP joint pathologies, including hallux rigidus are emerging.

Material And Methods

We studied 14 patients that underwent a Metatarsal phalangeal arthroscopy associated with percutaneous closing wedge osteotomy procedure during the period between 2013 to 2016, with the diagnostic of Hallux rigidus. All patients were classified accordingly to AOFAS scores for hallux, VAS for pain. Articular mobility of the first toe. We measured patient satisfaction to the procedure according to the Linkert scale

Results

The average follow-up was 12 months. The average age of our patients was 48 years. We had 4 male (28.6%) and 10 female (71.4.%) patients. 6 rights ( 42.8 %) and 8 lefts (57.2%). The average preoperative Visual Analog Scale of pain (VAS) 8.21 and postoperative was 1.53. The average preoperative AOFAS scales of 50.78 riced to 87.46 . Our patients had their ankles immobilized for an average of 19.45 ± 2.66 days. The mobility of the first toe was preoperative dorsal flexion 16.07 and plantar flexion was 11.78 degrees riced to 24.23 and 19.63 degrees. Our patients rated their personal satisfaction as very satisfied in 7 cases (50 %), satisfied 7 cases (50%), One patient had a edema for three months.

Conclusions

Hallux MTP joint arthroscopy is an effective procedure for grades 1 and 2, in combination of dorsal wedge osteotomy by minimal invasive surgery ( hybrid technique) may reduce postoperative swelling and pain and improve range of motion more effectively than open techniques. The technique minimizes dissection of the soft tissue envelope and provides visualization of the entire joint to assess and address concomitant pathologies. The Hybrid technique is an ideal treatment as it presents a good postoperative recovery with a swift return to patients preoperative daily activities.