Modern principles of hallux rigidus treatment

Introduction: pain in the area of the first toe caused by osteoarthritis of the first metatarsophalangeal joint (I MTP) is one of the most common pathologies of the human foot. In this pathology, painfulness is caused by arthritic changes in the joint, movements in the joint become painful, and joint mobility decreases [1]. The above is a clinical manifestation of hallux rigidus disease. When diagnosing this pathology, radiologic examination reveals narrowing of the articular gap of the first metatarsophalangeal joint and the presence of dorsal osteophytes of I MTP [3]. Patients with hallux rigidus are quite often encountered in the clinical practice of a physician. The etiology of hallux rigidus encompasses a variety of factors, and there are many approaches to the treatment of this disease. To date, the choice of treatment is based on a combined assessment of clinical and radiologic findings. The aim of this article is to review the current knowledge on the treatment of hallux rigidus. Research objective: to determine the modern principles of conservative and surgical treatment of the first metatarsophalangeal joint disease hallux rigidus. Materials and methods: A systematic literature search was conducted in relevant databases with the search terms “hallux rigidus”. The depth of the search was 24 years. The number of articles used for this paper was 42. A systematic review of research papers on the treatment of hallux rigidus was conducted according to the preferred reporting elements for systematic reviews and meta-analyses (PRISMA). Results: There are many treatment options for hallux rigidus in the current literature. Treatment of hallux rigidus can be divided into conservative and surgical treatment. Surgical treatment is usually divided into surgery that preserves the I MTP and surgery that does not preserve the I MTP. Treatment tactics depend on the severity of hallux rigidus, the clinical picture and the patient's complaints. For I-II degrees of first metatarsophalangeal joint damage, methods such as cheillectomy combined with or without Moberg surgery, shortening chevron osteotomy should be used. In the case of III degree hallux rigidus, there is experience with treatment by endoprosthesis of the I MTP, but this method of treatment has insufficient positive results and leads to difficulties in subsequent surgical interventions. This technique requires further observation and more in-depth clinical studies. Therefore, arthrodesis of the first metatarsophalangeal joint remains the "gold standard" for the treatment of patients with advanced hallux rigidus. However, other methods have emerged with comparable clinical results that allow preservation of joint motion, but there are not enough reliable results from long-term studies.