Rare Presentation of Flexor Hallucis Longus Tendinopathy, Idiopathic Hallux Saltans

Abstract

Category: Arthroscopy; Sports Introduction/Purpose: Ankle arthritis can be a significant source of pain and disability showing similar morbidity as arthritis in other joints like hip and knee. Nevertheless, ankle arthritis differs from arthritis in other joints because patients are often younger and have higher expectations and demands. After joint-sparing options fail, patients are usually limited to an ankle fusion or total ankle arthroplasty. However, it is not infrequent that these ablative procedures appear too aggressive to treat the underlying condition. As either fusion or replacement is not without complications, an intermediate option that does not burn any bridge is desirable. Ankle hemiarthroplasty is a one-piece implant system replacing the talar side of the tibiotalar joint. It also offers limited bone resection and more straightforward revision surgery than ablating procedures Methods: Prospective, single-center, non-comparative, non-randomized clinical study. Clinical, radiological, and functional outcomes (FAOS, FAAM, SF-36, SMFA, and VAS pain scores) were obtained at 3, 12 months, and last follow-up (mean 31.9 months). Results: Ten patients met the inclusion criteria; three were converted to total ankle replacement at 14, 16, and 18 months. PROMs comparisons were made between preoperative status and 3, 12 months, and last FU. Pain VAS score improved from 6.8 to 4.8 (P = 0.044). SF-36 Physical Health Component improved from 25.03 to 42.25 (P=0.030). SMFA Dysfunction and Bother indexes improved from 46.36. FAAM sports improved from 12.5 to 34.5 (P = 0.023) Conclusion: Patients undergoing hemiarthroplasty of the ankle joint exhibited significant pain reduction, functional improvements, and better quality of life in the midterm follow-up. This procedure offers an intermediate alternative for cases in which joint ablative procedures appear to be excessive surgery for the underlying condition.