Intermediate to long-term follow-up of medial-approach dorsal cheilectomy for hallux rigidus.
Dorsal cheilectomy of the hallux metatarsophalangeal (MTP) joint through a medial approach can effectively provide long-term relief of pain and improve function in symptomatic mild-to-moderate hallux rigidus, despite progression of generalized first MTP joint arthritic degeneration and/or loss of motion. Fifty-seven patients (75 feet) with arthritis of the first MTP joint underwent dorsal cheilectomy through a medial approach for hallux rigidus failing nonoperative management. Excision of the dorsal articular surface of the first metatarsal head and dorsal osteophytes was performed through a medial approach that also allowed for plantar capsular release and removal of lateral osteophytes. Minimum follow-up was 3 years (average, 63 months; range, 37-92 months). Fifty-two patients (68 feet) returned for clinical and radiographic evaluation. American Orthopaedic Foot and Ankle Society Hallux Rating scores improved from a preoperative average of 45 to 85 points at follow-up. Average dorsiflexion improved from 19 degrees to 39 degrees, and the average range of motion improved from 34 degrees to 64 degrees. Preoperative radiographic grade of arthritic degeneration was grade I in 17 feet, grade II in 39 feet, and grade III in 12 feet; at follow-up, the radiographic grade was grade I in 2 feet, grade II in 26 feet, and grade III in 40 feet. Thirty-two feet worsened one grade, 6 feet worsened two grades, and 28 feet demonstrated no change (12 of 28 were grade III, preoperatively). A dorsal spur recurred in 21 feet, 9 of which were symptomatic. Complications included two superficial wound infections and four transient paresthesias of the hallux, all of which resolved uneventfully.
Easley
M E
ME
Carolinas Medical Center, Charlotte, North Carolina, USA.
Davis
W H
WH
Anderson
R B
RB
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000150:complications; D005096:Exostoses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006214:Hallux / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications; D011859:Radiography