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Distally Based Capsule-Periosteum Interpositional Arthroplasty for Hallux Rigidus

Indications, Operative Technique, and Short-term Follow-up

Thomas S. Roukis Weil Foot and Ankle Institute, Des Plaines, IL.

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Adam S. Landsman Weil Foot and Ankle Institute, Des Plaines, IL.

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James B. Ringstrom Department of Podiatric Medicine and Surgery, Gundersen Lutheran Medical Center, La Crosse, WI.

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Peter Kirschner Department of Trauma and Reconstructive Surgery, St Vincenz and Elisabeth Hospital, Mainz, Germany.

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Markus Wuenschel Department of Trauma and Reconstructive Surgery, St Vincenz and Elisabeth Hospital, Mainz, Germany.

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Twelve patients (15 feet) with severe hallux rigidus underwent distally based capsule-periosteum interpositional arthroplasty of the first metatarsophalangeal joint (mean ± SD follow-up, 16.8 ± 7.0 months). Subjective evaluation was based on a modified version of the American Orthopaedic Foot and Ankle Society’s 100-point Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Objective evaluation consisted of preoperative and postoperative physical examinations (first metatarsophalangeal joint range of motion and axial grind testing) and radiographic evaluations (joint space width). The short-term results of this novel procedure showed subjective patient improvement and satisfaction, increased first metatarsophalangeal joint dorsal range of motion, maintained hallux plantar range of motion and power, and improved joint space width on anteroposterior and lateral radiographs. None of the patients developed a hallux hammer toe or extensus deformity or lesser metatarsalgia, and none required further surgical intervention. After describing the indications of the procedure and the surgical technique, the authors compare the results with those of the various other procedures available for the surgical treatment of hallux rigidus. (J Am Podiatr Med Assoc 93(5): 349-366, 2003)

Corresponding author: Thomas S. Roukis, DPM, Weil Foot and Ankle Institute, 1455 E Golf Rd, Ste 131, Des Plaines, IL 60016.