All about hallux rigidus percutaneous surgery

Dr Julien Lopez is a specialist in percutaneous hallux rigidus surgery and offers his patients an optimized care path.

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Minimally invasive and percutaneous hallux rigidus surgery: definition and causes

When this is possible, the surgeon prefers to use the minimally invasive and percutaneous surgery of the hallux rigidus in order to limit the complications of a traditional surgery.

Hallux rigidus: what is it?

Hallux rigidus (or hallux limitus) is the scientific name given to osteoarthritis of the big toe.

Hallux is the medical term for the big toe consisting of a metatarsal prolonged by two phalanges. The metatarsal and phalanges are connected to each other by inter-phalangial and metatarsal-phalangial joints allowing the mobility of the toe.

Hallux can be affected by several types of pathologies including hallux valgus or «onion» (deviation) and hallux rigidus which are often confused by patients.

The hallux valgus is a deformation of the big toe which has thus deviated from its axis. The resulting pain is characterized by friction pain between the metatarsal-phalangial joint and the shoe.

Hallux rigidus is the progressive itching of the metatarsal-phalangial joint between the metatarsus and the phalanges. The joint is the site of painful cartilage degradation that limits the mobility of joint surfaces. This is called osteoarthritis of the big toe. Osteoarthritis thus refers to a progressive disappearance of cartilage causing bone to rub against bone which can be particularly painful.

The causes

The causes of hallux rigidus are still unknown but some aggravating factors have been highlighted.

In people with hallux rigidus, most of the time we see:

  • Repetitive strain injuries due to intensive and aggressive joint sports (running, dancing, football, etc.)
  • The presence of an Egyptian foot (foot shape in which the big toe is longer than the other toes) putting more pressure on the joint
  • The presence of an old fracture or infection
  • Regular wearing of high heels or narrow shoes

It is possible to implement certain actions to prevent the occurrence of hallux rigidus. In particular, it is advisable to limit strain injuries by avoiding sports that are too aggressive for the joint. Swimming is for example to be preferred. It is also recommended to wear suitable shoes and avoid wearing shoes with heels or too narrow.

Hallux rigidus: minimally invasive surgery, symptoms and diagnosis

In case of hallux rigidus, minimally invasive surgery is recommended to limit complications for the patient.

Before determining the treatment to be implemented, Dr .Julien Lopez systematically conducts an examination and a clinical examination in order to make a diagnosis.

The symptoms

There are 3 main symptoms of hallux rigidus:

  • Pain in the big toe, sometimes associated with deformation (often dorsal).
  • Discomfort or pain when walking.
  • Deformation of the metatarsal-phalangian joint with a bony growth and a bump in the big toe preventing the wearing of tight shoes.
  • The stiffening of the joint makes walking very difficult for the patient and prevents him from mobilizing the big toe.

The diagnosis

In order to diagnose the pathology, Dr. Julien Lopez will first conduct a clinical examination. It aims to analyze the mobility of the metatarsal-phalangian joint, its deformation and its stiffness.

If the clinical examination suggests the presence of a hallux rigidus an x-ray is performed. An x-ray of the foot confirms the diagnosis and assesses the stage of osteoarthritis. In order to gather more information on the extent of the deformity and pathology, Dr. Julien Lopez will be able to prescribe additional exams such as CT, MRI, ultrasound or scintigraphy.

Non-surgical and minimally invasive hallux rigidus surgery

With regard to this pathology, the surgeon prefers to use the minimally invasive surgery of the hallux rigidus in order to guarantee the patient a quick and easy recovery.

Non-surgical treatment

In case of hallux rigidus, it is possible to go to non-surgical treatments.

Julien Lopez will initially prefer non-surgical treatment of the pathology.

There are different non-surgical treatments for hallux rigidus:

  • Adaptation of the shoe with the wearing of wide and adapted shoes
  • Introduction of an anti-inflammatory painkiller treatment to limit pain
  • Making infiltrations of cortisone derivatives or visco-supplementation
  • Wearing of orthopedic soles
  • Physiotherapy
  • Mesotherapy
  • Adaptation of sports practice
  • Food supplements or medicines

On the other hand, no non-surgical treatment allows to «recreate» the cartilage or to correct existing deformations. All these provisions generally make it possible to stop the evolution of hallux rigidus and to effectively soothe pain.

Minimally invasive surgery

Julien Lopez takes care to adapt the technique used on a case-by-case basis. Thus, the surgical technique used will not be the same depending on whether the hallux rigidus is at a moderate or an advanced stage.

In the case of a severe hallux rigidus, the intervention consists in permanently blocking the metatarsal-phalangian joint with 2 screws or a plate. In this case, we are talking about arthrodesis. The objective is to condemn this joint in order to remove the pain felt. Dr Julien Lopez will also be able to rework the bones with a tool to restore normal bone structure. This procedure can be performed by a minimally invasive technique (small incision of 3 to 4 cm) or by percutaneous technique: 3 small incisions of less than 2 mm coupled with a visual inspection by per-operative radiography.

Thanks to the use of the percutaneous technique (sometimes referred to as hallux rigidus laser surgery), the procedure can be performed on an outpatient basis. Once the operation is complete, the patient can continue the recovery process at home.

So that the patient feels no pain, Dr.Julien Lopez performs the operation under local anesthesia. The goal of this technique is to temporarily stop the transmission of nervous messages throughout the leg. To do this, anesthesiste injects local anesthetics around the peripheral nerves to numb the operated area. There are many advantages of local anesthesia, such as a reduction in the side effects of general anesthesia and post-operative pain.

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Minimally invasive procedure on hallux valgus rigidus: post-operative care and recovery

Following the minimally invasive procedure on hallux valgus rigidus, the patient must wear therapeutic shoes prescribed by the surgeon for a month and a half. It will be possible to resume walking from the first day. The post-operative dressing should be redone every 2 days for 2 weeks after the procedure and should not be wet. Post-operative consultations are held with Dr.Julien Lopez to ensure the patient’s recovery and to make dressing changes.

In the case of osteoarthritis of the big toe, percutaneous surgery allows the patient to resume driving after 21 days of recovery and sports activities after 2 to 3 months.

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The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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