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Forefoot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Most cases have bilateral affection and a positive family history. The pain in hallux rigidus is generally due to the arthritis. Other causes of pain being pressure on the dorsomedial cutaneous nerve of the first ray or the osteophytes rubbing against footwear. The incidence of night pain is uncommon. Activities such as running, going up and down the stairs and wearing high heels are associated with worsening of pain. The alteration of gait may cause pain across the outer border of the foot.
Leg, foot and nail disease in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
M. Alam, R. K. Scher, P. I. Schneiderman
Digital deformities of the feet are hallux valgus (bunion), hallux limitus and hammer toe contractures or claw toes4,66. Bunions entail a lateral deviation of the great toe with medial prominence of the metatarsal head at the first metatarsophalangeal joint. Hallux limitus is an osteoarthritis of the first metatarsophalangeal joint. Severe hallux limitus culminates in hallux rigidus, in which the patient finds it difficult to propel the foot forward when walking because of diminished joint motion. Treatments for bunions and related disorders are ice compresses, wider shoes, shoes stretched by a shoemaker, bunion shields and surgery. With hallux limitus, conservative treatment may be of limited benefit. Like bunions, hammer toe contractures and claw toes are exacerbated by narrow shoes. Hammer toe contractures result from the hyperflexion of small toes and the resulting curling of the toes. With age, increasingly rigid and painful contractures occur in association with hyperkeratotic lesions. For relief, patients may try moleskin, corn pads, toe splints, lamb’s wool, open toe shoes and emolliation. Severe claw toes and hammer toes may require surgical correction.
The Fascial System in Walking
Published in David Lesondak, Angeli Maun Akey, Fascia, Function, and Medical Applications, 2020
Issues that may affect the efficiency, timing, or aim of the trigger and catapult mechanism of toe-off should be investigated in patients presenting with low back and hip soft tissue dysfunction and with walking impairments of almost any nature. Range of motion of the great toe joint should be functionally assessed to ensure it can contribute during gait with differential tests to check for hallux rigidus and limitus. As in most cases, conservative treatment should be attempted first to alleviate hallux limitus. Knee, hip, and low back issues may be relieved through the use of rocker type shoes in cases of hallux rigidus.
Diagnosis and conservative management of great toe pathologies: a review
Published in Postgraduate Medicine, 2021
Nicholas A. Andrews, Jessyca Ray, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Pathologies involving the great toe can be divided into acute and chronic conditions. Lasting less than 6 weeks, acute conditions of the great toe include hallux fractures and dislocations, turf toe, sand toe, and various acute sesamoid disorders [5]. Chronic pathologies affecting the anatomic great toe include hallux rigidus, hallux valgus, and chronic sesamoid disorders. In addition, the primary care physicians will encounter systemic diseases such as flare ups of gout or rheumatoid arthritis affecting the great toe. However, this review will focus only on the musculoskeletal pathologies affecting the anatomic great toe. Specifically, this review endeavors to characterize the typical patient history, physical exam, radiographic features, conservative measures, and brief surgical management for acute and chronic great toe pathologies.
Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus
Published in Modern Rheumatology, 2020
Kosuke Ebina, Makoto Hirao, Hideki Tsuboi, Shoichi Kaneshiro, Masataka Nishikawa, Atsushi Goshima, Takaaki Noguchi, Hiroyuki Nakaya, Yuki Etani, Akira Miyama, Kenji Takami, Jun Hashimoto, Hideki Yoshikawa
Concerning interposition techniques, many previous reports demonstrated their efficacy in the treatment of hallux rigidus. Hamilton et al. demonstrated suturing the extensor hallucis brevis tendon to the flexor hallucis brevis tendon [16] and Aynardi et al. demonstrated good outcomes for the same procedure (patient-reported outcome was good or excellent in 89.5%, with mean follow-up of 62.2 months) [5]. Recently, Vulcano et al. also reported the good-long term outcomes (patient satisfaction of 92.9%, with a mean follow-up of 11.3 years) of this procedure [6], suggesting the long-term efficacy of capsular interposition. A previous report demonstrated that interpositioned-capsule remained as fibrocartilage tissue by biopsy examination [5], which may contribute to pain reduction and improvement of range of motion by preserving sliding surface of articular cartilage in this study.
Proximal metatarsal wedge osteotomy for metatarsus primus elevatus associated with rheumatoid forefoot deformity: a case report
Published in Modern Rheumatology Case Reports, 2019
Hallux rigidus describes painful limited range of motion at the first metatarsophalangeal joint. In previous studies, hallux rigidus was observed in 2.1–28% of patients with RA [2,3,7]. Hallux flexus is considered to be an extreme form of hallux rigidus in which the proximal phalanx is held in a plantarflexed position and weight is not supported by the metatarsal head, but is instead transferred to the first interphalangeal joint. In Kirkup’s series, no toes were classified as hallux flexus [3]. The present case could be considered to be hallux flexus. The role of metatarsus primus elevatus in the pathogenesis of hallux rigidus has remained an issue of debate [5,6]. Matsumoto et al. [8] reported MPE of 2.4 ± 3.0 mm (mean ± standard deviation) in their study population, estimating that less than 5% of patients with RA have MPE > 8.4 mm. In addition, among 80 patients with RA who underwent surgical treatment for rheumatoid foot deformities at our hospital, only 9 (11%) had MPE > 8 mm. Thus, metatarsus primus elevatus is a rare deformity pattern among patients with RA.