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Resumen: Hallux rigidus es la patología degenerativa de la articulación metatarsofalángica del hallux. Esta patología provoca dolor y disminución en el movimiento. Existen múltiples tratamientos quirúrgicos para esta patología, todas con sus respectivas indicaciones. Presentamos el caso de un paciente de 54 años de edad con el diagnóstico de hallux rigidus quien tenía afectación únicamente del aspecto lateral de la cabeza del metatarsiano. Este paciente fue tratado con un procedimiento quirúrgico novedoso, se realizó una hemiartroplastía de interposición utilizando el extensor hallucis brevis asociado a una queilectomía y exostectomía. El paciente tuvo una favorable evolución clínica con mejoría evidenciado por escalas clínicas, con resolución de la sintomatología y sin complicaciones. La hemiartroplastía de interposición utilizando el extensor hallucis brevis es un tratamiento exitoso de preservación articular y del movimiento para el hallux rigidus en pacientes jóvenes en los que hay afectación unicompartimental lateral de la cabeza metatarsiana, en quienes es importante preservar el movimiento.

Abstract: Hallux rigidus is the degenerative pathology of the metatarsophalangeal joint of the hallux. This pathology causes pain and decreased movement. There are multiple surgical treatments for this pathology, all with their respective indications. We present the case of a 54-year-old patient diagnosed with hallux rigidus who had only the lateral aspect of the metatarsal head affected. This patient was treated with a novel surgical procedure, performing an interposition hemiarthroplasty using the hallucis brevis extender associated with a cheilectomy and exostectomy. The patient had a favorable clinical evolution with improvement evidenced by clinical scales, with resolution of the symptoms and without complications. Interposition hemiarthroplasty using the extensor hallucis brevis is a successful joint and movement preservation treatment for hallux rigidus in young patients with lateral unicompartmental involvement of the metatarsal head, in whom it is important to preserve movement.

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Hallux rigidus is the degenerative pathology of the metatarsophalangeal joint of the hallux. This pathology causes pain and decreased movement. There are multiple surgical treatments for this pathology, all with their respective indications. We present the case of a 54-year-old patient diagnosed with hallux rigidus who had only the lateral aspect of the metatarsal head affected. This patient was treated with a novel surgical procedure, performing an interposition hemiarthroplasty using the hallucis brevis extender associated with a cheilectomy and exostectomy. The patient had a favorable clinical evolution with improvement evidenced by clinical scales, with resolution of the symptoms and without complications. Interposition hemiarthroplasty using the extensor hallucis brevis is a successful joint and movement preservation treatment for hallux rigidus in young patients with lateral unicompartmental involvement of the metatarsal head, in whom it is important to preserve movement.

Hallux rigidus es la patología degenerativa de la articulación metatarsofalángica del hallux. Esta patología provoca dolor y disminución en el movimiento. Existen múltiples tratamientos quirúrgicos para esta patología, todas con sus respectivas indicaciones. Presentamos el caso de un paciente de 54 años de edad con el diagnóstico de hallux rigidus quien tenía afectación únicamente del aspecto lateral de la cabeza del metatarsiano. Este paciente fue tratado con un procedimiento quirúrgico novedoso, se realizó una hemiartroplastía de interposición utilizando el extensor hallucis brevis asociado a una queilectomía y exostectomía. El paciente tuvo una favorable evolución clínica con mejoría evidenciado por escalas clínicas, con resolución de la sintomatología y sin complicaciones. La hemiartroplastía de interposición utilizando el extensor hallucis brevis es un tratamiento exitoso de preservación articular y del movimiento para el hallux rigidus en pacientes jóvenes en los que hay afectación unicompartimental lateral de la cabeza metatarsiana, en quienes es importante preservar el movimiento.

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ABSTRACT Hallux rigidus produces a decrease in the dorsiflexion of the first metatarsophalangeal joint and is usually associated with the appearance of osteophytes. Hemiarthroplasty in the first proximal phalanx is a recommended surgical procedure in patients with advanced grade of hallux rigidus. Finite element analysis allows us to understand the biomechanical behavior of the foot. The objective of this work is to evaluate the biomechanical effects of an hemi implant placed in first proximal phalanx. Two models of finite elements are going to be compared, one free of pathologies and the other with a hemiarthroplasty in the first ray of the foot. We detected after inserting the prosthesis in the model that passive windlass mechanism is lost, and the lesser toes become overloaded, which leads to a loss of efficiency in gait as well as being able to cause postsurgical medical complications.

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Abstract Objective Historical results of arthroplasty of the first metatarsophalangeal joint (1MTP) are relatively poor; however, improvements in the understanding of the normal foot biomechanics, implant materials and design currently make arthroplasty a reasonable option in appropriately selected patients. The present study aimed to compare the clinical and radiographic results of 1MTP arthrodesis and arthroplasty in the treatment of hallux rigidus and to present a rationale for patient selection for arthroplasty. Methods A total of 36 patients (38 feet) with hallux rigidus submitted to surgery (12 arthrodesis and 26 arthroplasties) were prospectively included in the study. Pain was assessed using the visual analogue scale (VAS) and the functional status was assessed using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale. Complications and radiographic results were also analyzed, and survival rates were calculated for both procedures. Results All of the patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty had better functional results on the AOFAS-HMI scale (89.7 versus 65.7 points; p < 0.001) and better pain relief (VAS 1.6 versus 3.9 points; p = 0.002) when compared with the group submitted to arthrodesis. There was one case of infection in the arthroplasty group and 2 cases of pseudarthrosis in the arthrodesis group. Conclusion Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to preserve the biomechanics of the foot. While the two surgical methods yielded good clinical results, selected patients submitted to arthroplasty had better clinical scores and lower revision rates.

Resumo Objetivo Historicamente, os resultados da artroplastia da primeira articulação metatarsofalângica (1MTP) eram relativamente ruins; no entanto, melhorias na compreensão da biomecânica normal do pé, nos materiais e no design dos implantes, tornam a artroplastia um tratamento aceitável em pacientes selecionados. O presente estudo pretendeu comparar os resultados clínicos e radiográficos da artrodese com os da artroplastia da 1MTP no tratamento de hallux rigidus e apresentar um racional para seleção de pacientes para artroplastia. Métodos Um total de 36 pacientes (38 pés) com hallux rigidus operados (12 artrodeses e 26 artroplastias) foram prospectivamente incluídos. A dor foi avaliada com recurso à escala visual analógica (VAS) e o resultado funcional usando a escala American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI). As complicações e os resultados radiográficos foram também registrados e a taxa de sobrevida calculada para os dois procedimentos. Resultados Todos os pacientes referiram uma melhoria significativa na dor e nos resultados funcionais após a cirurgia. Os pacientes submetidos a artroplastia tiveram melhor resultado funcional na escala AOFAS-HMI (89,7 versus 65.7 pontos; p < 0.001) e melhor alívio da dor (VAS 1,6 versus 3,9 pontos; p = 0,002) quando comparados com os doentes submetidos a artrodese. Registrou-se um caso de infecção no grupo da artroplastia e 2 casos de pseudoartrose no grupo da artrodese. Conclusão A artrodese permite alívio da dor e resultados satisfatórios, mas altera a biomecânica da marcha. Tal como a artrodese, a artroplastia melhora a dor significativamente, sendo uma alternativa mais fisiológica para preservar a biomecânica do pé. Apesar dos dois tratamentos terem bons resultados clínicos, em pacientes selecionados, a artroplastia teve melhores resultados clínicos e menor taxa de revisão.

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Introduction: species of the family Cyperaceae are commonly used by the population to treat gastric disorders.However, there are a few ethnopharmacological studies about this family Lagenocarpus rigidus (Kunth) Ness, Cyperaceae, is one of the most widespread swamp species. Objective: evaluate the gastric activity of L. rigidus and its chemical characterization. Methods: ethanolic extract of L. rigidus (ELR) leaves prepared by percolation was subjected to total polyphenol and flavonoid quantification, as well as HPLC quantification of some flavonoids. Angiotensin converting enzyme (ACE) inhibition was determined by colorimetric assays.The gastric effects of ELR were tested in male Wistar rats (n = 6 each group) treated with different doses (600, 60 and 6 mg/kg i.p.) ELR.Gastric lesions were induced by administration of indomethacin (30 mg/kg s.c.).The number of ulcers and the index of mucosal damage (IMD) were determined taking into account the color, edema and bleeding of gastric lesions, the number of petechiae, and the number and size of the ulcers. Statistical analysis of data was performed with one-way ANOVA followed by Tukey's test; significance was p < 0.05. Results: ELR inhibited the ACE (68.5±18.1%) at a concentration of 100 mg/mL.Oral administration of ELR (6, 60 and 600 mg/kg) showed protective activity against indomethacin-induced gastric injury. Total polyphenols in ELR were 157.7 ± 5.8 mg pirogalol/mg equivalent flavonoids and 66.9 ± 3.1 µg equivalent quercetin/mg. Conclusion: L. rigidus protects against acute gastric damage induced by indomethacin in an independent dose manner.

Introducción: las especies de la familia Cyperaceae popularmente se utilizan para tratar trastornos gástricos. Sin embargo, hay pocos estudios etnofarmacológicos sobre esta familia. Lagenocarpus rigidus (Kunth) Ness, Cyperaceae, es una de las especies más grandes de población en pantano. Objetivo: evaluar la actividad gástrica de L. rigidus, junto a su caracterización química. Métodos: el extracto etanólico de hojas de L. rigidus (ELR), preparado por percolación fue objeto de cuantificación de polifenoles y flavonoides totales, cuantificación por HPLC de algunos flavonoides. La inhibición de la enzima convertidora de angiotensina (ECA) se realizó por ensayos colorimétricos. Los efectos gástricos de ELR se llevó a cabo en ratas Wistar macho (n = 6, cada grupo), el tratamiento con diferentes dosis (600, 60 y 6 mg/kg ip) de ELR. Las lesiones gástricas se indujeron mediante la administración de indometacina (30 mg/kg sc). El número de úlceras y signos de puntuación del índice de lesión de las mucosas (IMD) se evaluó teniendo en cuenta el color, edema y hemorragia de las lesiones gástricas, el número de petequias, y el número y tamaño de las úlceras. El análisis estadístico de los datos se realizó mediante ANOVA 1 vía, seguido por el test de Tukey y significación fue de p < 0,05. Resultados: ELR inhiben la ACE (68,5 ± 18,1 %) a una concentración de 100 mg/mL. La administración oral de ELR (6, 60 y 600 mg/kg) mostró un efecto protector gástrico contra inducido por indometacina. Los polifenoles totales de ELR fue 157,7 ± 5,8 mg equivalente de pirogalol/mg de flavonoides y 66,9 ± 3,1 μg equivalentes de quercetina/mg. Conclusiones: L. rigidus protege contra el daño gástrico agudo inducido por la indometacina en una organización independiente de la dosis.

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O hálux rígido é uma afecção frequente da primeira articulação metatarsofalangeana, que provoca limitação progressiva da dorsiflexão do dedo, formação osteofítica dorsal e dor. A classificação clínico-radiográfica de Couglin e Shurnas (2003) mostra-se um bom parâmetro na orientação do tratamento, que apresenta diversas possibilidades de acordo com a evolução da patologia. Objetivo: O presente trabalho pretende avaliar os resultados funcionais e o grau de satisfação de pacientes portadores de hálux rígido tipo II submetidos a queilectomia associada a osteotomia da falange proximal do hálux. Método: Foram avaliados 15 pacientes entre janeiro de 2012 e janeiro de 2014, com seguimento mínimo de 01 ano, utilizando-se como instrumentos de avaliação a medida de amplitude articular, a Escala Funcional da American Orthopedics Foot and Ankle Society e a Escala Analógica Visual de Dor. Resultados: Todos os pacientes apresentaram melhora significativa da função, com um aumento médio de 47,60 pontos no pré-operatório para 82,07 pontos no pós-operatório pela Escala de Avaliação Funcional American Orthopedics Foot and Ankle Society e uma diminuição média da dor de 3,20 pontos no pré-operatório para 0,27 pontos no pós-operatório segundo os critérios da Escala Analógica Visual de Dor. Observou-se também um aumento da amplitude de movimento pós-operatória, com média de 41,33° no pré-operatório e 78,93º no pós-operatório. Conclusão: Podemos inferir que a associação de queilectomia com osteotomia da falange proximal nos casos de hálux rígido tipo II é uma excelente opção de tratamento, que resulta em boa função da articulação e elevado grau de satisfação do paciente (AU)

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Objetivo: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap em pacientes com diagnóstico de hállux rígidus (HR). Método: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) – analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. Resultados: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós--operatórios de seis meses e atual não mostram diferença estatística o que indica manutenção dos parâmetros durante esse intervalo. Conclusão: A hemiartroplastia da primeira metatarsofalangeana é opção reprodutível e segura para o tratamento cirúrgico do hállux rígidus II e III, com significativa melhora dos parâmetros avaliados para a população estudada. Nível de Evidência IV, Série de casos.

Objective: To report the results of medium-term follow-up after deploying arthrosurface-Hemicap in patients with diagnosis of hállux rígidus (HR). method: eleven patients underwent partial arthroplasty of the first metatarsal-phalangeal joint. six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the american orthopaedic foot and ankle society (aofas) scales for hallux, visual analogical scale (vas) – analog functional pain - and motion range in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. Results: the results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. the comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. conclusion: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rígidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

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BACKGROUND: The purpose of this study was to evaluate the clinical and radiological results in a group of patients who underwent first metatarsophalangeal joint arthrodesis with an endomedullary screw fixation technique (MPA-E). METHODS: Between 2003 and 2009, 101 metatarsophalangeal arthrodesis were performed in 76 patients. There were 64 women and 12 men with an average age of 68 years. The indication for surgery was osteoarthritis with severe pain and functional limitation. Patients were evaluated radiologically and with the American Orthopaedic Foot & Ankle Society scoring system (AOFAS) at an average follow-up of 32 months (range, 24-92 months). RESULTS: The success rate was 93%, with an increase of the average preoperative AOFAS from 38.5 points to 85.5 points postoperatively (P < .0001). The consolidation rate after radiological evaluation was 90.1%; there were 5 cases (5.0%) with asymptomatic nonunion and 5 cases (5.0%) with poor results because of symptomatic nonunion. Screw removal was needed in 4 feet (4.0%), and 2 feet (2.0%) had acute postoperative superficial infection. No implant cutout was observed. CONCLUSION: The MPA-E technique provided consistent and high functional outcomes. This valid and effective alternative should be considered as an option for hallux metatarsophalangeal arthrodesis. LEVEL OF EVIDENCE: Level IV, retrospective case series.

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OBJECTIVE: To report the results of medium-term follow-up after deploying Arthrosurface-HemiCap((r)) in patients with diagnosis of Hállux Rigidus (HR). METHOD: Eleven patients underwent partial Arthroplasty of the first metatarsal-phalangeal joint. Six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) scales for hállux, Visual Analogical Scale (VAS) - analog functional pain - and range of motion in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. RESULTS: The results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. The comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. CONCLUSION: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rigidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

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Bailahuén (Haplopappus rigidus, Haplopappus baylahuen, Haplopappus multifolius and Haplopappus taeda; Asteraceae) are medicinal shrubs native to the Andes Mountains of Chile widely used to treat hepatic ailments. At present, exploitation of bailahuén is based on wild collections, affecting the abundance of natural populations. Variability of biomass production and concentration of active compounds in different wild populations of the four Haplopappus species was studied in order to select the best plant material for cultivation. Resins were extracted with dichloromethane and essential oils by distillation. Biomass production of the populations was highest for H. baylahuen and H. rigidus compared with the other species, reaching between 0.56 and 1.61 kg and 1.11-1.48 kg per plant, respectively. No differences were found among populations of the same species. In some H. rigidus populations, the resin content was about a third of the dry weight, whereas plants of H. multifolius had mean values of about 8 percent. In H. baylahuen (11.3-27.7 percent) the resin content of leaves differed significantly among populations, whereas the essential oil ranged from 0.02-0.38 mL*100g DM-1 in H. baylahuen, 0.03-0.5 mL*100 g DM-1 for H. rigidus, and 0.08-0.35 mL*100 g DM-1 for H. taeda. Resin content in stems differed only among H. baylahuen (6.3-15.5 percent) and H. rigidus (10.7-21.2 percent) populations. No significant differences in essential oil content among species could be detected because of the large amount of variation observed among populations. The variation between plants of the same population may indicate favorable selection potential for future breeding programs.

Bailahuén (Haplopappus rigidus, Haplopappus baylahuen, Haplopappus multifolius y Haplopappus taeda; Asteraceae) son arbustos medicinales de la Cordillera de los Andes Chilena ampliamente usados para tratar malestares hepáticos. Actualmente, la explotación del bailahuén se basa en la recolección silvestre, afectando su abundancia. La variabilidad en diferentes poblaciones silvestres de las cuatro especies de Haplopappus fue usada en orden a determinar la potencialidad para seleccionar el mejor material vegetal para cultivo en producción de biomasa y contenido de principios activos. La resina se extrajo por inmersión en diclorometano y el aceite esencial por destilación. Los mayores rendimientos de biomasa se observaron en H. rigidus y H. baylahuen, con valores poblacionales que fluctuaron entre 1,11-1,48 y 0,56-1,61 kg planta-1, respectivamente, sin presentar diferencias entre poblaciones de la misma especie. El contenido de resinas alcanzó en algunas poblaciones de H. rigidus hasta un tercio del peso seco, mientras que en H. multifolius fue de aproximadamente 8 por ciento. En hojas, sólo se observaron diferencias significativas en el contenido de resinas entre poblaciones de H. baylahuen (11,3-27,7 por ciento). El contenido de aceites esenciales en hojas permitió diferenciar poblaciones de H. baylahuen (0,02-0,38 mL*100g MS-1), H. rigidus (0,03-0,50 mL*100g MS-1) y H. taeda (0,08-0,35 mL*100g MS-1). En tallos, el contenido de resina difirió significativamente entre poblaciones de H. baylahuen (6,3-15,6 por ciento) y H. rigidus (10,7-21,2 por ciento). La alta variación del contenido de aceite esencial entre poblaciones no permitió establecer diferencias entre especies. La variación entre poblaciones de la misma especie sugiere un buen pronóstico para futuras selecciones y mejoramiento genético.

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OBJETIVO: Avaliar os resultados preliminares da prótese METIS-Newdeal® como tratamento de hallux rigidus grau III/IV. MÉTODOS: Estudo prospectivo de oito próteses MTF colocadas em seis pacientes entre nov/2007 e jul/2009. A idade média foi de 55 anos e o tempo de seguimento após a cirurgia de 50 semanas. Na avaliação dos resultados foi utilizado o escore AOFAS-MTF e controle imageológico por radiografia. RESULTADOS: Verificou-se um aumento pontual significativo do escore AOFAS-MTF que passou de 42p pré-operatório para 82p após a cirurgia (↑1,95x), tendo sido ao nível da função o maior ganho. Radiologicamente não se identificaram intercorrências. Dos cinco pacientes operados, apenas um se mostrou descontente com a cirurgia, após o surgimento de infecção precoce no local cirúrgico, sendo que corresponde à única complicação pós-op encontrada. CONCLUSÃO: A artroplastia total metatarsofalângica METIS-Newdeal® apresenta resultados promissores no curto prazo. No entanto, é necessário avaliar um maior número de casos com um tempo de seguimento mais longo para que se possa obter conclusões mais consistentes.

OBJECTIVE: To evaluate the preliminary results from the METIS-Newdeal® metatarsophalangeal prosthesis for treating hallux rigidus grade III/IV. METHODS: This was a prospective study on eight metatarsophalangeal prostheses that were placed in six patients between November 2007 and July 2009. The patients' mean age was 55 years and the mean follow-up after the surgery was 50 weeks. The results were evaluated using the AOFAS-MTF score and x-ray images as controls. RESULTS: The AOFAS-MTF score increased significantly from 42p before the surgery to 82p after the surgery (↑1.95x), mainly due to improvement in the functional level. No intercurrences were identified radiologically. Among the five patients who underwent operations, only one expressed dissatisfaction with the surgery: this was expressed after early infection appeared at the surgical site, and it was the only postoperative complication found. CONCLUSION: Total metatarsophalangeal arthroplasty using METIS-Newdeal® presented promising short-term results. However, evaluations on a larger number of cases with a longer follow-up are needed in order to draw more consistent conclusions.

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OBJECTIVE: To evaluate the preliminary results from the METIS-Newdeal(®) metatarsophalangeal prosthesis for treating hallux rigidus grade III/IV. METHODS: This was a prospective study on eight metatarsophalangeal prostheses that were placed in six patients between November 2007 and July 2009. The patients' mean age was 55 years and the mean follow-up after the surgery was 50 weeks. The results were evaluated using the AOFAS-MTP score and x-ray images as controls. RESULTS: The AOFAS-MTP score increased significantly from 42p before the surgery to 82p after the surgery (↑ 1.95x), mainly due to improvement in the functional level. No intercurrences were identified radiologically. Among the five patients who underwent operations, only one expressed dissatisfaction with the surgery: this was expressed after early infection appeared at the surgical site, and it was the only postoperative complication found. CONCLUSION: Total metatarsophalangeal arthroplasty using METIS-Newdeal(®) presented promising short-term results. However, evaluations on a larger number of cases with a longer follow-up are needed in order to draw more consistent conclusions.