Hallux rigidus- fusion or implant?
When it comes to treating hallux limitus and hallux rigidus, I’ve been an implant guy for years. Implant arthroplasty (Mayo-Keller bunionectomy) is simply what I learned to use in my residency training 30 years ago. In cases of stage 4 hallux limitus (HL), I’ll opt for a great toe implant over a fusion any day. My logic is that it’s simple; what I would want to have? I wouldn't want a stiff toe. I’d like to maintain the natural range of motion of my great toe joint.
I’ve watched with interest as the podiatry community seems to have followed the orthopedics community into a trend to fuse stage 4 HL. Fusion has long been the procedure of choice in orthopedics.
But I was heartened by several articles in The Journal of Foot and Ankle Surgery this year that have been advocating the use of implants in cases of stage 4 HL. Ironically, some of these articles were written by orthopedists (JFAS is a publication of the American College of Foot and Ankle Surgeons – the academic branch of podiatric surgery).
Sure, there are indications for great toe joint fusions, but I just can’t see using it on a regular basis when the use of an implant is a reasonable and reliable choice. Heck, foot and ankle surgeons are all gun-ho on doing ankle joint replacements. Why not the same emphasis on great toe implant arthroplasty.
Bottom line is the procedure works. So why fuse the joint?
Jeffrey A. Oster, DPM