The big toe joint goes through a lot of stress over the years with walking, cement floors, tight shoes, activities and sports. Hallux Limitus / Ridigus refers to painful osteoarthritis of the big toe and is a disorder of the joint located at the base of the big toe. Over the past 10 years of practicing I have been looking for procedures to maintain pain-free motion, reduce downtime from surgery, and improve patient satisfaction.
Hallux Limitus / Ridigus causes pain and stiffness in the joint, and with time, it becomes increasingly difficult to bend the big toe. As the disorder progresses symptoms can include pain and difficulty wearing shoes because of bone spurs that develop over time (see picture). This condition also causes dull pain in the hip, knee and lower back due to changes in the way you walk. In severe cases, a limp can develop. Ideally addressing the arthritis early is best with conservative options or joint re-arrangement surgery. I will discuss this in future articles.
Historically there have been 2 surgical options for the treatment of Hallux Limitus / Rigidus:
1- Cheilectomy: A removal of bone spurs of the big toe: In the picture below you can see what the arthritis looks like on the xrays and also when the joint is exposed
2: 1st metatarsal phalange fusion ( arthrodesis): This procedure completely fuses the joint so no motion occurs. This is usually a very successful surgery; however, ideally I like to this surgery for severe cases and as one gets older. The big issue with a fusion is the use of limited shoe gear and additional joint compensation due to the fusion which can then cause other joints to become painful as one ages.
The 3rd Option: ArthroFLEX® Decellularized Dermal Allograft
There are several implants on the market which i have used and revised due to loosening or impaction corrosion. ArthroFLEX®(1) is an acellular dermal extracellular matrix intended for supplemental support and covering of surfaces. This process allows the matrix to retain its growth factors, native collagen scaffold and elastin, which is required for healing. Elastin and collagen provide unparalleled strength for supplemental support and covering for soft tissue repair. I have used this product for the repair of tendons with good success. When reassessing the condition of hallux limitus most is related to either trauma, overuse or abnormal biomechanics.
When assessing if the patient is a good candidate for this surgery I look at both cartilage loss and mechanics of the foot in all directions. Arthroflex gives the joint a second life on resurfacing the complete joint not just 1 cm of the joint like Cartiva(another common synthetic cartilage implant). The below case study gives a step by step on how the joint appears, why resurfacing is an indication and addressing the biomechanics.
The outpatient surgery takes approximately 60 minutes from start to finish. Patients are allowed to be fully weightbearing in a boot without crutches for 2 weeks then can transition into regular running shoes. Overall patient satisfaction is high and long term outlooks are optimistic. Over the next year I will continue to add patient testimonials, pictures and videos of the range of motion. Please LIKE us on facebook to get notified of further additions to this procedure and patient outcomes.
If you are interested in this surgical option and or looking for a 2nd opinion schedule a consultation with Dr Martins.
You can book an appointment online at https://www.jackson-podiatrist.com/
or call our 517-879-4241.
Darryl J Martins DPM FACFAS