NEW PROCEDURE FOR SEVERE GREAT TOE ARTHRITIS SEEN AS MAJOR ADVANCEMENT

Des Plaines, IL December 8, 2003 -- Severe great toe arthritis, known in medical communities as "hallux rigidus", is a major cause of foot pain. When conservative treatments such as ice, stiff-soled shoes, specialized shoe inserts, oral anti-inflammatories, cortisone injections, and physical therapy fail to provide long-term relief, surgical treatment is usually needed. The traditional surgical procedures involve complete removal of the joint followed by either fusing the ends of the toe bones together or using a plastic-like implant as a spacer. While these techniques each have there proper indications, a new procedure, developed by Dr. Thomas S. Roukis, a podiatric foot and ankle surgeon, and colleagues, uses the body's own tissues to create a durable, pain-free cushion which surrounds the joint and allows immediate weightbearing after surgery. Once fully healed, no specialized shoe gear or inserts are usually needed.

"Great toe arthritis, which we call "hallux rigidus", where "hallux" means great toe and "rigidus" means stiffened or rigid, is estimated to affect 1:40 people living in the USA and is a major cause of foot pain" according to Dr. Roukis. In hallux rigidus, hard bone-spurs build-up around the top and side of the great toe joint which limit movement and create painful swelling deep in the joint. The majority of those who suffer from hallux rigidus respond to conservative treatments. However, for those who fail to realize long-term pain relief, surgery is usually the only treatment option left. Dr. Roukis explains that, "Traditional surgical treatment options for severe or end-stage hallux rigidus have involved: (1) removal of the base of the great toe knuckle; (2) complete removal of the joint and then knitting the ends together; or (3) complete removal of the joint and insertion of a synthetic plastic-like implant. While each of these procedures has there own correct indications, they also each have a number of potential unwanted side-effects. Problems such as a short, floppy great toe; permanently stiffened great toe which makes the neighboring joints prone to developing arthritis and shoe-related irritation; and a loss of great toe function which causes a shift in pressure to the remaining lesser toes that can in turn become painful are frequently encounter following these surgeries."

However, Dr. Roukis and colleagues have developed a new surgical technique which uses the body's own tissues to replace the diseased and damaged great toe joint. Dr. Roukis states that, "While completing my AO International Trauma Fellowship in Germany, I conducted research which compared X-rays of the great toe before surgery and the actual cartilage damage found in surgery. It was during this research that I noticed that the tissues surrounding the great toe joint in patients with hallux rigidus were thickened, spongy, and very strong. It was from this simple observation that the procedure my colleagues and I have published was developed and perfected." The actual procedure involves cleaning and reshaping the great toe joint by removing the bone spurs and diseased cartilage sections and then re-lining each of the bone ends with the neighboring tissues. In a recent scientific paper co-authored by Dr. Roukis and published in the Journal of the American Podiatric Medical Association, the procedure was shown to significantly reduce pain, increase the total motion of the great toe joint, and stand the test of time.

Dr. Roukis has recently treated a semi-professional soccer player from Italy who had failed several previous surgeries on his great toes for hallux rigidus and has now been able to return to competitive play. "In my opinion" states to Dr. Roukis, "this procedure works equally well regardless of age or activity level. It certainly leaves the proverbial door open for a more extensive surgery at some point in the future if needed. Interestingly, none of the patients we followed required further surgery, special shoes or inserts, and no-one developed any pain elsewhere in the foot. It may not seem like a big deal, but my patients like the idea that we are using their body's own tissues rather than metal screws or silicone-rubber implants. We usually perform the procedure under gentle sedation as an out-patient with full weightbearing allowed the same day regardless if one or both feet are operated on. A brief physical therapy program is used to facilitate healing after which normal shoes and activities are returned to over a few weeks time."

The full scientific paper can be found at: Roukis TS, et al. Distally-based capsule-periosteum interpositional arthroplasty for hallux rigidus: Indications, operative technique, and follow-up. J. Amer. Podiatr. Med. Assoc. 93(5): 349-366, 2003.

Dr. Roukis is in private practice in Illinois at the Weil Foot and Ankle Institute (http://www.footankledeformity.com or http://www.weil4feet.com), has office locations in Des Plaines, Rolling Meadows, and Libertyville, and is on-staff at Holy Family Hospital, St. Alexius Medical Center, Highland Park Hospital, and Lake Forest Hospital. To learn more about this new procedure or for a consultation or second opinion with Dr. Roukis write: Weil Foot & Ankle Institute, 1455 E. Golf Road, Suite 131, Des Plaines, Illinois 60016; call (847) 390 7666; or email him at troukis@footankledeformity.com





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