Prevalence of and risk factors for hallux rigidus: a cross-sectional study in Japan.

BACKGROUND: Hallux rigidus (HR) is a common osteoarthritis of the first metatarsophalangeal joint. However, the epidemiology and risk factors of this pathology have yet to be clarified. METHODS: We have been conducting cohort studies among individuals over 50 years old every 2 years since 1997. This study analyzed data from the 7th to 10th checkups in 2009, 2011, 2013, and 2015. We investigated the prevalence of HR and its risk factors in a total of 604 individuals (mean age, 67.1 ± 6.4 years; 208 men, 396 women). Radiographic HR was defined as Hattrup and Johnson classification grade 1 or higher. Knee osteoarthritis (KOA) was scored according to the Kellgren-Lawrence grading system. Radiographic KOA was defined as grade 2 or higher. Cases with a hallux valgus (HV) angle of 20° or higher were defined as showing HV. Statistical analyses were performed using the Kruskal-Wallis test, Fisher's exact test, logistic regression modeling, and the Cochran-Armitage trend test. All p-values presented are two-sided and values of p < .05 were considered statistically significant. RESULTS: The prevalence of HR was 26.7% (161/604). Rates of grade 0, 1, 2, and 3 HR according to the Hattrup and Johnson classification were 73.3% (443/604), 16.4% (99/604), 8.0% (48/604), and 2.3% (14/604), respectively. Overall ratio of symptomatic HR was 8.1%. Univariate analysis revealed KOA, gout attack (GA), and HV as significantly associated with HR. The same factors were confirmed as independent risk factors for HR in multivariate analysis. All parameters were significantly associated with HR. Odds ratios of KOA, HV, and GA for HR were 1.73, 3.98, and 3.86, respectively. The presence or absence of KOA was significantly associated with severity of HR. CONCLUSIONS: This study revealed that the prevalence of HR in the elderly (≥50 years) was 26.7%. KOA, HV, and GA were independent risk factors for HR. KOA was associated with severity of HR.

Hallux rigidus - Osteoarthritis of the first MTP-joint. Surgical and patient-reported results from Swefoot.

BACKGROUND: Swefoot is a Swedish national registry, that covers surgery in the foot and ankle. Surgical treatment of hallux rigidus (HR) vary within and between countries. The aim of this study was to report baseline variables for patients with HR. METHODS: We extracted baseline characteristics, surgical procedures and patient-reported data for patients with HR entered in the registry during the period January 2014 to August 2019. RESULTS: By August 2019, 1818 patients were reported in the registry. 68.9% of the patients were women, the average age was 58 years, the mean BMI was 26.4kg/m2. 41.9% of the patients underwent a cheilectomy,19.8% a metatarsal osteotomy, 34.3% a fusion, 0.2% an arthroplasty, 0.3% Keller's procedure and 3.5% other methods. The preoperative summary score for SEFAS (Self-reported Foot and Ankle Score) was 26 and for EQ-5D (Euroqol-5 Dimension) 0.60. CONCLUSION: This study is the first report from Swefoot regarding HR.

Prevalence of Hallux Rigidus in Patients With End-Stage Ankle Arthritis.

Arthritis of the foot is a significant cause of pain and disability. The prevalence of foot arthritis in adults aged ≥50 has been reported to be 17%. Of those, 25% are estimated to be radiographic arthritis of the first metatarsophalangeal joint. The purposes of this study were to (1) identify the prevalence of radiographic hallux rigidus (HR) in a population of patients with end-stage ankle arthritis relative to that reported in the general population and (2) identify associations between the presence of HR and demographic and clinical factors. A total of 870 feet in 809 subjects with end-stage ankle arthritis who underwent primary total ankle arthroplasty between November 2006 and November 2017 were included. Feet were stratified by patient age: <40, 40 to 59, 60 to 79, and ≥80 years. Etiology of ankle arthritis was classified as inflammatory, post-traumatic, primary, and other. The prevalence of HR in the study group was 72.9%. The prevalence of HR was slightly higher in patients with inflammatory arthritis (odds ratio 1.31, 95% confidence interval 0.73 to 2.32) and primary arthritis (odds ratio 1.18, 95% confidence interval 0.86 to 1.63). The prevalence of HR increased with age (p = .01). In conclusion, the prevalence of radiographic HR in a population with end-stage ankle arthritis was significantly higher relative to patients without documented comorbidities in the foot and ankle. Increasing age was associated with a higher prevalence of the disease.

Propuesta de algoritmo global de tratamiento del hallux rigidus según la medicina basada en la evidencia / Proposed global treatment algorithm for hallux rigidus according to evidence-based medicine

Introducción. El hallux rigidus es la artrosis más frecuente en el pie y tobillo. Existen numerosas revisiones respecto al tratamiento quirúrgico, pero escasas publicaciones que aborden la eficacia del tratamiento conservador. Objetivo. Presentar un algoritmo global de tratamiento completo para todos los grados de esta enfermedad. Métodos. Revisión sistemática de la evidencia disponible hasta octubre de 2013 utilizando las siguientes fuentes: Pubmed y PEDro database (physiotherapy evidence database) de artículos sobre tratamiento de hallux rigidus que comuniquen sus resultados y de los que pudieran obtenerse grados de recomendación. Resultados. Obtuvimos 112 artículos sobre tratamiento conservador y 609 sobre tratamiento quirúrgico. Finalmente solo 4 cumplían los criterios de inclusión. Conclusiones. El uso de ortesis a medida o modificaciones del calzado, la infiltración con hialuronato, la queilectomía en grados moderados y la artrodesis metatarsofalángica en grados avanzados, son los únicos procedimientos contrastados con grado de evidencia B o moderada en el tratamiento del hallux rigidus (AU)

Introduction. Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment. Objective. To present a comprehensive algorithm for treatment of all grades of this disease. Methods. Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence. Results. A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria. Conclusions. The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus (AU)

Prevalencia de patología del pie en una población geriátrica y su impacto en la función, la marcha y el síndrome de caídas / Prevalence of foot conditions in a geriatric population and their impact on mobility, gait and tendency to falls

Introducción. La patología del pie es común en la población geriátrica. Se conoce poco sobre su prevalencia y el impacto que tiene sobre la función, la marcha y las caídas. Material y métodos. Se realizó una valoración geriátrica a 171 mujeres institucionalizadas. Se tomaron fotografías del pie que fueron valoradas por un ortopedista y una dermatóloga. Se realizó análisis multivariado para estimar el efecto de las variables independientes sobre función, marcha y síndrome de caídas. Resultados. Las alteraciones del pie más encontradas fueron la presencia de dedos en garra (122), callos (79) e insuficiencia vascular periférica (74). El hallux rígido (OR 24,897, IC del 95%, 1.231-503.542) y la insuficiencia vascular periférica (OR 2.481, IC del 95%, 1.095-5.623) se relacionaron con alteración en la marcha; ambas se asociaron a dependencia a las actividades instrumentales de la vida diaria (OR 44.166, IC del 95%, 2.402-812.233, y OR 2.659, IC del 95%, 1.069-6.615). El hallux rígido se asoció a caídas (OR 19.27, IC del 95%, 1.102-337.26). La tiña se relacionó con dependencia en las actividades de la vida diaria (OR 11.52, IC del 95%, 1.325-100.125). Conclusiones. La patología del pie es muy común en la población geriátrica. Únicamente el hallux rígido y la insuficiencia vascular periférica impactaron en la función y la marcha(AU)

Introduction. Foot disease is common among the elderly. Little is known about its prevalence and impact over mobility, gait and tendency to fall. Material and methods. A geriatric history was taken from 171 women living in a long-term care facility. Photographs were taken of the feet and evaluated by an orthopaedic surgeon and a dermatologist. A multivariate analysis was made to assess de effect of the independent variables over mobility, gait and tendency to fall. Results. The foot diseases most commonly found were hammer toes (122), callus (79) and peripheral vascular disease (74). Hallux rigidus (OR 24.897, 95% CI, 1.231-503.542) and peripheral vascular disease (OR 2.481, 95% CI, 1.095-5.623) seemed to be associated with changes in gait; both where associated with dependency on instrumental activities of daily living (OR 44.166, 95% CI, 2.402-812.233, and OR 2.659, 95% CI, 1.069-6.615). Hallux rigidus was related to falls (OR 19.27, 95% CI, 1.102-337.26). Tinea pedis was associated with dependency in activities of daily living (OR 11.52, 95% CI, 1.325-100.125). Conclusions. Foot disorders are common in the elderly. Only hallux rigidus and peripheral vascular disease had an impact on function and gait(AU)

Hallux rigidus: a cross-sectional study to evaluate clinical parameters.

BACKGROUND: Hallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment. METHOD: A cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18-70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions. RESULTS: Seventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14-68 years) years and median HR duration 6 years (1-33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found (r=0.84, p=0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI degrees ) was greater than normal (< or =10 degrees ). A correlation between HAI and reduced 1st MTPJ ROM was found (r=0.92, p=0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found (r=.78, p=.05). A positive relationship was found between 2nd toe length and 1st MTPJ pain (p=0.001<0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found (r=0.78, p=0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion (p<0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings. CONCLUSIONS: HR was associated with female gender, bilateral involvement, older age groups, increased HAI degrees, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.

[Surgical treatment of hallux rigidus]. / Die operative Therapie des Hallux rigidus.

Hallux rigidus is a deformity of the first metatarsophalangeal joint. Symptoms include a painful reduction of mobility and increasing stiffness in the big toe. Only when conservative therapeutic methods have failed should surgical options be considered. The surgical technique depends on the stage of the deformity. For stadium I and II, the joint should be retained, for example by cheilectomy. In this case, a correction osteotomy of the phalanx or first metatarsus can follow. For stadium III and IV, the usual procedure is arthrodesis. Complications can involve an incorrect positioning of the big toe, pseudoarthrosis and arthrosis of the interphalangeal joint. For less active patients, a resection arthroplasty is also possible.