Update Hallux rigidus

Wesentliche Merkmale des Hallux rigidus – der Arthrose des Großzehengrundgelenks – sind die eingeschränkte Beweglichkeit der Großzehe im Metatarsophalangealgelenk und die Schmerzen. Eine konservative Therapie sollte der operativen Versorgung grundsätzlich vorgeschaltet werden, bei welcher gelenkerhaltende und gelenkresezierende Verfahren zur Verfügung stehen.

Kernaussagen

• Die Arthrose des Großzehengrundgelenks wird mit dem Begriff Hallux rigidus bezeichnet.

• Die klinische und radiologische Diagnostik sind wegweisend.

• Im Rahmen der konservativen Therapie, die einer operativen Versorgung immer vorgeschaltet sein sollte, zeigen die Schuhmodifikation mit Hallux-rigidus-Einlagen und Abrollhilfen eine Schmerzlinderung. Gelenkinfiltrationen haben nur eine kurzfristige Wirkung.

• Verkürzende Osteotomien bergen die Gefahr einer postoperativen Transfermetatarsalgie.

• Die Arthrodese des MTP-I-Gelenks stellt weiterhin den Goldstandard in der Behandlung der fortgeschrittenen Arthrose des MTP-I-Gelenks dar. Für das klinische Ergebnis ist die Positionierung der Großzehengrundgelenkarthrodese und des IP-Gelenks entscheidend.

• Die Hemiarthroplastik mit einem Cartiva-Implantat wird kontrovers diskutiert.

• Der Markt der Großzehengrundgelenkprothesen ist überschaubar. Für einige Modelle können gute klinische Ergebnisse gezeigt werden, die denen einer MTP-I-Arthrodese jedoch nicht überlegen sind.

Schlüsselwörter

Metatarsophalangealgelenk - Großzehengrundgelenk - Arthrose - Arthrodese - Fußchirurgie

Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2023

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