Hallux rigidus: Great progress for an old disease

Purpose of review: This paper highlights the recent progress in understanding hallux rigidus, or osteoarthritis of the great toe, a very common problem of active middle-aged and older patients. The recent advances make surgical decision-making for this diagnosis more complicated. The reader should leave with a better understanding of recently published investigations and how they impact treatment needs of a varied patient population. Recent findings: Researchers continue to try to alleviate pain at the arthritic first metatarsophalangeal joint and restore foot function. The cause of the condition continues to be better understood with improved science. Arthrodesis still remains the gold standard, but resection arthroplasty techniques offer good results with better motion. Joint replacement still remains of questionable merit, although hemiarthroplasty seems to have established fine short-term results. The metatarsal osteotomies are far more complicated than expected and long-term results are needed to assess their ultimate role for this condition. Summary: The recent advances in the treatment of hallux rigidus have been exciting and have changed treatment options. The basic understanding of the problem has been addressed in several landmark articles. Despite literature documenting excellent results with metatarsophalangeal joint fusion, patient demand has led surgeons to develop other treatment options. The failure of any artificial implant to gain widespread acceptance in this joint has inspired a variety of interposition arthroplasties with excellent early results. Long-term follow-up of joint-preserving and joint-replacement techniques will be essential in guiding operative decision-making.