HALLUX LIMITUS / HALLUX RIGIDUS
STIFF BIG TOE
The most common site of arthritis in the foot is at the base of the big
toe. This joint is called the metatarso-phalangeal, or MTP joint. It's
important because it has to bend every time you take a step. If the
joint starts to stiffen, walking can become painful and difficult.
In the MTP joint, as in any joint, the ends of the bones are
covered by a smooth articular cartilage. If wear-and-tear or injury
damage the articular cartilage, the raw bone ends can rub together. A
bone spur, or osteophyte, may develop on the top of the bone. This
overgrowth can prevent the toe from bending as much as it needs to when
you walk. The result is a stiff big toe, or Hallux Rigidus (also referred to as Hallux Limitus).
Hallux Rigidus/Limitus usually develops in adults between the ages of 30 and 60
years. No one knows why it appears in some people and not others. It
may result from an injury to the toe that damages the articular
cartilage or from differences in foot anatomy that increase stress on
the joint.
Great Toe - Existing Treatments
Conservative Options
Rest, Ice, NSAIDS, Shoe Modification
Initial
treatment should include rest, ice, NSAID's, and shoe modifications. A
stiff- soled shoe to decrease dorsiflexion combined with an enlarged
toe box to accommodate swelling may be adequate to relieve symptoms. A
rocker-bottom shoe can be prescribed, but this may adversely affect
athletic performance and thus be unacceptable.
Physical Therapy
Treatment
by a certified therapist including possible use of orthotics may be
useful in alleviating pain and improving function of the toe.
Steroid Injection
A
corticosteroid injection can provide some relief. However, injections
should be used sparingly because they do cause damage to the remaining
cartilage surface.
Surgical Options
Cheilectomy (kI-lek'-toe-me)
This surgery is usually
recommended when damage is mild or moderate. It involves removing the
bone spurs (also known as osteophytes) as well as a portion of the foot
bone, so the toe has more room to bend. The incision is made on the top
of the foot. The toe and the operative site may remain swollen for
several months after the operation, and you will have to wear a
wooden-soled sandal for at least two weeks after the surgery. But most
patients do experience long-term pain relief.
Arthrodesis (are-throw-dee'-sis) or Fusion
Fusing
the bones together (arthrodesis) is often recommended when the damage
to the cartilage is severe. The damaged cartilage is removed and pins,
screws, or a plate are used to fix the joint in a permanent position.
Gradually, the bones grow together. This type of surgery means that you
will not be able to bend the toe at all.
For the first six
weeks after surgery, you will have to wear a cast and then use crutches
for about another six weeks. You typically won't be able to wear high
heels, and you may need to wear a shoe with a rocker-type sole.
Hemiarthroplasty (hem-E are-throw-plas'-tee)
Older
patients
who place few functional demands on the feet may be candidates
for a hemiarthroplasty. The phalangeal joint surface is removed and an
artificial device is implanted. This procedure has been around for over
10 years and is very popular. Common concerns are that the arthritis,
and therefore the problem area, is located on the opposite side
(metatarsal) of the joint to where the implant is placed. There are
also issues with a congruent fit and shortening of the entire joint.
Newer techniques that address the metatarsal side of the joint are
considered the "next generation" of hemiarthroplasty of the toe.
Arthroplasty (are-throw-plas'-tee)
Older
patients who place few functional demands on the feet may be candidates
for joint replacement surgery. The joint surfaces are removed and an
artificial joint is implanted. This procedure may relieve pain and
preserve joint motion. however there is extensive bone removal which can make future surgeries more difficult.
Keller Procedure (kel-her)
This
procedure combines soft tissue releases with resection of the end of
the proximal phalanx (toe bone) and is usually done for less active
older individuals, due to the loss of ability to push-off during
walking.
HemiCAP® Resurfacing System
What is a HemiCAP and is it right for me?
If you are a middle aged person age 40-70 and have pain in your
joints then that is a good starting point for this discussion. As we
get older, the pain in our joints becomes more of a nuisance and
requires some attention. You may have tried simple things such as
physical therapy and injections into your joints but they just aren't
working anymore. You may have even tried a surgical procedure such as
an arthroscopy or a microfracture procedure but the pain and ache has
returned especially after basic activity such as sports or chasing the
kids around. It may be time to investigate a more durable procedure
such as the HemiCAP from Arthrosurface.
An easy way to describe the HemiCAP implant is to correlate it to a
dental procedure. When you have a cavity in your tooth, the dentist
places a small filling into the cavity. Your joint cartilage can
develop small "cavities" or potholes that need to be addressed as they
can cause pain. An orthopaedic surgeon, who is trained on the
Arthrosurface system, can perform a minimally invasive surgery that will
place a small implant into the defect into that "cavity" or defect
which can alleviate your pain and make your cartilage into a smooth
surface once again.
The Arthrosurface HemiCAP resurfacing system is a comprehensive
surgical solution for the treatment of articular cartilage lesions and
defects in the body’s weight bearing, non-weight bearing and extremity
joints. The system is similar to a dentist that uses a filling to cap a
cavity in the tooth. The system has 3 elements:
-
A family of “patient matching” cobalt chrome CAP implants;
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A central fixation component; and
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An instrument set used to map the joint surface, prepare the joint/bone and implant the prosthesis.
The HemiCAP system precisely aligns the surface of the implant to the
contours of the patient's articular surface, filling the defect and
restoring a smooth and continuous joint surface. The implants are
designed to match the surface and contours being restored. The
instruments and techniques apply to any joint surface, spherical,
aspherical, convex, concave or convex-concave.
The procedure is designed to get patients back to work and life with
minimal disruption. Surgery is typically performed in an outpatient
center and the procedure takes less than one hour.
HemiCAP System Advantages
for the Patient
-
HemiCAP technology was designed for patients who live longer,
continue working, and retain more active lifestyles, and have an
increased need for joint preserving treatments
-
Procedure may be performed on outpatient basis
-
HemiCAP allows for preservation of the joint and surrounding bone
and maintains existing joint biomechanics, thereby allowing normal
motion
The HemiCAP implants are comprised of two parts: an articular cap and
a fixation component. The articular component is a rounded, cap-like
implant made from a cobalt chrome (CoCr) alloy with a central post on
its underside. Cobalt chrome is a material that has been used in total
joint reconstruction devices for decades. This material has proven to
provide a safe, effective and strong weight-bearing surface in joints.
This metal alloy exhibits lubricious qualities very similar to articular
cartilage when implanted in a joint.
The fixation component looks like a screw and is made of Titanium
(Ti), another material that has been used in orthopaedics for decades.
The two components are connected together via a morse taper which is a
very secure method of fixation.
The HemiCAP surgical procedure begins when an articular defect is
confirmed. The diameter of the defect is determined and a guide wire is
introduced into the middle of the defect. The fixation component is
implanted to establish the mechanism for anchoring the articular
component . Using the fixation component as a central axis, specially
designed instruments are used to map the contours of the patient's
articular cartilage surrounding the defect and to prepare the tissue in
and around the defect for the resurfacing implant. Once the site is
prepared, the HemiCAP resurfacing implant is brought into position and
seated.