SmartHallux® Method
Smarthallux explains to you
All you need to know
on the rigid hallux
What does hallux rigidus mean?
The term hallux rigidus describes a painful condition of the big toe at the joint between the metatarsal and phalanx, characterized by limited movement (mainly dorsiflexion) and the formation of a bone (exostosis) on the dorsum of the joint, and not on the medial portion as occurs in hallux valgus.
The terms “hallux rigidus” (or rigidus) and “hallux limitus” are used interchangeably although, according to some, hallux limitus is characterized by a decrease in dorsiflexion, while hallux rigidus is distinguished by an absence of movement.
This is a pathology that often involves both feet (in about 80% or more of patients), although symptoms often involve the dominant limb first.
It is the most common foot pathology in males, and the second most common in females, after hallux valgus.
What causes hallux rigidus?
The cause of hallux rigidus, as well as that of hallux limitus and hallux valgus, has not yet been determined, although several predisposing factors have been cited.
The most common cause cited is trauma, which can occur as a single episode, such as an intra-articular fracture or a crush injury, but hallux rigidus can also occur with repetitive microtrauma.
The most likely cause, in the absence of trauma, is related to a condition known as elevated first metatarsal, characterized by a higher first metatarsal in relation to the lesser metatarsals, caused in turn by excessive mobility of the first cuneometatarsal joint.
Hallux rigidus may be associated with other conditions, particularly biomechanical metatarsalgia.
Hallux rigidus: symptoms
The most common symptom is limited dorsiflexion , together with pain and the appearance of dorsal exostosis.
The most specific test shows limited dorsiflexion that occurs when the ankle is at 90°, as when the patient is carrying weight, while when the ankle is not at 90°, the movement of the big toe is almost normal. Limited functionality of the big toe leads to increased workload (a "functional overload") of the other toes, often associated with the onset of biomechanical metatarsalgia and toe claw.
The patient tends to rest on the outer edge of the foot and, in some patients, the fifth toe tends to "subdue" the fourth toe, creating a clinical condition called bunionette or "tailor's foot", characterised by an exostosis on the lateral edge of the fifth toe typical of tailors who used to rest their feet on the outer edge, favouring the onset of this overload.
Often the patient does not even notice the limited dorsiflexion of the big toe, but presents to the clinic complaining of metatarsalgia or a deformity affecting the second, third, fourth or fifth toe.
Do you suspect you have hallux rigidus?
If you suspect you have hallux rigidus, contact your doctor and have a weight-bearing X-ray of your foot performed.
The specialist, simply by observing the patient walking barefoot, and noting the presence and distribution of hyperkeratosis (common calluses), is able to reach a diagnosis and, above all, differentiate hallux rigidus from hallux valgus and evaluate the degree of degeneration of the joint in order to decide on the most effective treatment.
Diagnosis of hallux rigidus
The specialist, simply by observing the patient walking barefoot, and noting the presence and distribution of hyperkeratosis (common calluses), is able to reach a diagnosis.
To decide on a patient's treatment plan, the doctor uses a weight-bearing foot X-ray. This is an examination performed with the patient standing, because the foot works while standing and the condition manifests itself while standing. Ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) are second-level tests, useful in certain situations, but they often provide the surgeon with less information than X-rays, as they are performed with the patient lying down.
When does it become symptomatic?
Hallux rigidus becomes symptomatic, and therefore pathological, when the compensatory mechanisms fail, causing pain in the patient.
A specialist visit is essential to make a diagnosis .
In fact, it is the orthopedic specialist in foot and ankle surgery who treats hallux rigidus.
The specialist, simply by observing the patient walking barefoot, and noting the presence and distribution of hyperkeratosis (common calluses), is able to reach a diagnosis.
To decide on a patient's treatment plan, the doctor uses a weight-bearing foot X-ray. This is an examination performed with the patient standing, because the foot works while standing and the condition manifests itself while standing. Ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) are second-level tests, useful in certain situations, but they often provide the surgeon with less information than X-rays, as they are performed with the patient lying down.
Treatment of hallux rigidus
Conservative treatment for symptomatic hallux rigidus depends on the patient's symptoms and the extent of the disease. In the early stages, the use of an insole can relieve pain from hallux rigidus, particularly if the primary symptom is metatarsalgia. However, even insoles are not free from complications, particularly related to the thickness of the insole, which can worsen the dorsal exostosis and the toe pinching with the shoe upper. Furthermore, insoles, like the many commercially available braces, do not have a "corrective" effect; they merely improve foot support, and their effect disappears when they are discontinued. Therefore, there is no effective method for "unblocking" hallux rigidus other than surgery.
In cases where an insole is not indicated, or the patient complains of pain despite using the insole, surgery represents a reliable solution.
SmartHallux's goal for your surgery
SmartHallux's goal is to revolutionize the treatment of hallux rigidus and all the most common foot and ankle conditions. To achieve this goal, we adopt the best surgical techniques, orthopedic devices, instruments, and materials available on the market.
This is why we propose ourselves as private healthcare at an accessible and financeable cost. Unfortunately, public and subsidized healthcare have spending limits that place limits on the use of materials, instruments and structures.
With SmartHallux you will have access to the best possible treatments, in excellent facilities and without having to wait for public health authorities.
Anesthesia
Surgical techniques have undergone an important evolution compared to the past, starting from anesthesia and post-operative pain control.
The anesthesia we use at SmartHallux does not involve painful ankle injections or uncomfortable spinal anesthesia, nor does it require general anesthesia. With ultrasound guidance, our anesthesiologists are able to identify the nerves and, with a single injection behind the knee, they can selectively "numb" the nerve structures necessary and sufficient to perform the procedure painlessly, leaving the patient with full leg mobility and bladder control. Sedation allows the patient to avoid anxiety and, often, wake up immediately after the surgery. This type of anesthesia also allows for anesthesia to be prolonged for up to 24-48 hours, reducing or even eliminating post-operative pain, without any risks or contraindications.
SmartHallux®: Innovative Minimally Invasive Technique
Our surgical techniques
The surgical techniques currently available at SmartHallux are divided into minimally invasive, BOAT (best of all techniques), and mixed techniques. The most appropriate technique will be chosen by the surgeon and the patient during the specialist consultation.
Mixed technique, percutaneous and open minimally invasive
The most frequently used and recognized technique is a mixed, percutaneous and open, minimally invasive technique, in which an osteotomy of the first metatarsal is performed to restore it to the ideal position and, depending on the specific case, a percutaneous osteotomy of the proximal phalanx of the first toe and, in cases of metatarsalgia and/or bunionette, a percutaneous osteotomy of the lateral metatarsals.
In addition to correcting the functionality of the foot, it is also possible to correct its aesthetics, improving the shape and length of the toes and decreasing their diameter in order to obtain a foot with a more pleasant appearance and which fits more easily with the desired shoes, even more tapered and with a high heel.
The percutaneous technique
The percutaneous technique offers the great advantage of the total absence of post-operative scars.
Only in the most serious cases, where the arthrosis is very advanced, can we resort to arthrodesis of the big toe.
The minimally invasive open technique
The minimally invasive open technique, on the other hand, allows for greater precision and the osteotomy to be fixed with innovative biocompatible materials that allow for extremely high precision and early recovery.
Duration of the intervention
Hallux rigidus surgery is usually performed as a day surgery procedure. It lasts about 30 minutes.
Hallux rigidus: the post-operative period
The patient enters the hospital in the morning and returns home the same evening, walking immediately in a specific post-operative shoe and with the aid of two crutches for the first 3-4 days.
Hallux rigidus surgery: recovery times
The day after surgery, when sensation has fully recovered, the patient can walk with full support of the foot, wearing a flat post-operative shoe specifically designed for this type of surgery.
The first check-up is performed approximately 15 days after surgery. During this check-up, the stitches are removed and a second bandage is applied. Generally, 7-10 days after surgery, thanks in part to our special post-operative shoe, the patient can return to driving. A second check-up is performed approximately 4 weeks after surgery, during which all bandages are removed and the patient can return to weight-bearing without any aids, wearing a pair of comfortable shoes. Full recovery generally occurs 2-3 months after surgery. The patient can return to contact sports after 3-4 months. Water walking rehabilitation, or hydrokinesitherapy, can help the patient recover more quickly.
Complications of hallux rigidus surgery
The risks and complications associated with hallux rigidus surgery are very rare, especially with non-invasive surgery. They include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms, and skin complications, nerve damage with loss of sensation, persistent pain at the scar, delayed union, pseudoarthrosis, and joint stiffness.
The use of antibiotics and low molecular weight heparin further reduces the risk of complications.
Why choose SmartHallux for surgery?
Our doctors, led by Dr. Manzi, have extensive experience in treating hallux rigidus with a very high percentage of satisfied patients.
The secrets of our success lie in the use of the best surgical and anesthesiological techniques, and the use of cutting-edge, top-quality materials.
Waiting times for hallux rigidus surgery through the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. In some cases, the wait can be several months or even years. SmartHallux offers the opportunity to access the procedure more quickly, avoiding long waiting lists.
Regarding costs , hallux rigidus surgery can vary depending on the technique used, the complexity of the case, and the healthcare facility where it is performed. Typically, the average cost is around €9-€10.000. At SmartHallux, thanks to the advanced technique used and our collaboration with several clinics, you can get a significantly more competitive price.
SmartHallux® Certified Clinics
FAQ
There are several options for booking a visit with Dr. Manzi
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan and Naples
It is also possible to book a telemedicine visit.
