Hallux Rigidus

IntroductionFoot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function.MethodsParticipants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and center of pressure excursion index from plantar pressure scans were used to create foot posture and function subgroups. Adjusted odds ratios of having each specific disorder were calculated for foot posture and function subgroups relative to a referent 3 quintiles.ResultsPes planus foot posture was associated with increased odds of hammer toes and overlapping toes. Cavus foot posture was not associated with the foot disorders evaluated. Odds of having hallux valgus and overlapping toes were significantly increased in those with pronated foot function, while odds of hallux valgus and hallux rigidus were significantly decreased in those with supinated function.ConclusionsFoot posture and foot function were associated with the presence of specific foot disorders.

BackgroundHallux 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.MethodsWe 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 ResultsThe 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.ConclusionsThis 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.

Background and purpose - Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T > MIC) for Staphylococcus aureus (4 µg/mL).Patients and methods - 10 patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time [range]: 65 minutes [58-77]). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours.Results - A cefuroxime concentration of 4 µg/mL was reached within 23 minutes in all compartments and patients. For cefuroxime the T > MIC (4 µg/mL) ranged between 4.8 and 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet leg. Comparable T > MIC and penetration ratios were found for the first and second dosing intervals.Interpretation - Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 µg/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.

BackgroundFunctional hallux rigidus is characterized by limited first metatarsophalangeal (MTP) dorsiflexion during weight bearing conditions, but normal motion otherwise. This phenomenon alters the biomechanics of the foot, potentially leading to first MTP pain and trauma to the MTP cartilage. The purpose of this study is to assess the role of the flexor hallucis longus (FHL), plantar fascia (PF), and fibro-osseous tunnel in functional hallux rigidus.MethodFourteen cadaveric lower limbs were analyzed. The Dananberg technique was used to dorsiflex the great toe and radiographs were taken after each of the following manipulations, measuring the dorsiflexion angle of the first MTP. The plantar fascia was transected with a Z-cut, shortened approximately 10 mm, then repaired. The fibro-osseous tunnel was released. The FHL was transected with a Z-cut then shortened approximately 7 mm.ResultsAverage passive dorsiflexion of the first MTP is 23.8° (95% CI 19.7-27.9) prior to manipulation. Shortening the plantar fascia and FHL did not decrease the MTP dorsiflexion significantly beyond baseline (p>0.05). Lengthening the plantar fascia increased the dorsiflexion by 6.7° (28.1% increase) and lengthening the FHL increased dorsiflexion by 7.0° (29.4% increase). The difference between the two methods was not significant (p>0.05). Releasing the fibro-osseous tunnel alone increased the dorsiflexion 3.4° (14.4% increase) and was not significantly different from PF or FHL lengthening.ConclusionFunctional hallux rigidus causes limitation of first MTP dorsiflexion when the first metatarsal head is prevented from plantarflexing. There is no difference between the contribution of the FHL versus the plantar fascia to functional hallux rigidus. The true etiology may be multifactorial and involve other structures such as the flexor hallucis brevis, first metatarsal, and gastrocnemius/soleus/achilles complex. As such, no clear surgical intervention can be recommended to improve functional hallux rigidus except in cases with clear-cut causes of stenosis.