A Novel Treatment of Severe Hallux Rigidus with Hyaluronic Acid Scaffold Interpositional Arthroplasty with Platelet-rich Plasma Injection Cheilectomy First Metatarsophalangeal Joint: A Surgical Technique

Hallux rigidus predisposes a person to insidious moderate to severe pain on ambulation and chronic disability. Current treatment options include conservative management with injections, anti-inflammatory medications, physical therapy, orthotics, and shoe wear modifications. For patients unresponsive to conservative measures, operative treatment with cheilectomy is considered the ideal treatment for moderate stages, and arthrodesis is the gold standard treatment for advanced hallux rigidus. Interpositional arthroplasty and osteotomies are alternative options for joint-preserving procedures. Emerging treatments in first-world countries include 1st metatarsophalangeal arthroplasty. This paper describes a case of severe hallux rigidus with poor response to conservative management. Due to the patient's desire to return to predisease level of active lifestyle and the limited availability of surgical implants in the country, cheilectomy combined with the technique of hyaluronic acid nonwoven scaffold interposition with platelet-rich plasma infusion of the first MTP joint was performed. Improvement in functional and pain scales was noted at 1 year postoperative, and the patient was back to his premorbid state at 2 years postoperative. No recurrence of pain and no limitation on ROM were noted on the most recent follow-up.