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Surgical Decision Making for Advanced Hallux Rigidus
Hallux rigidus is the most common arthritic condition of the foot and occurs more commonly in women than in men. It also is one of the most common pathologies affecting the first MTP joint. Fusion of the MTP joint is the standard of care for advanced hallux rigidus. Successful arthrodesis alleviates most of the pain emanating from the joint and lessens the effect of transfer pain by redistributing weight bearing back to the hallux. Dorsal cheilectomy is an option in some patients with advanced hallux rigidus who are hesitant to commit to fusion. However, nonsurgical treatment should always be offered, even to patients with advanced arthrosis, and it should be considered before proceeding with surgical treatment. Arthrodesis has a relatively low complication rate. Fusion rates tend to be high even with early weight bearing if proper joint preparation is performed and adequate fixation is achieved. Nonunion is rare. This chapter focuses on the surgical decision making in the management of patients with advanced arthrosis as determined by patient- and surgeon-related factors, with special emphasis on the arthrodesis technique.