title: Dorsal wedge phalangeal osteotomy for grade II-III hallux rigidus in active adult patients.
abstract: BACKGROUND
  The purpose of this study was to evaluate prospectively the results of the dorsal wedge phalangeal osteotomy for treating moderate hallux rigidus.
  
  
  METHODS
  The prospective study included 42 consecutive feet in 40 active patients, with an average age of 55.1 (range, 41-65) years. Clinical evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale, range of motion, and subjective patient satisfaction. Radiographic evaluation was performed, including linear and angular measurements. The average follow-up was 2.7 (range, 2-3.8) years.
  
  
  RESULTS
  The preoperative and postoperative mean AOFAS scores were 51.7 and 88.8, respectively (P = .001), and for pain VAS were 7.6 and 1.9, respectively (P = .001). Good and excellent results at final follow-up were seen in 34 feet. All patients returned to their previous activities. Satisfaction with surgery was good or excellent in 39 patients. The average passive metatarsophalangeal (MTP) dorsiflexion improved from 20.3 to 55.7 degrees (P = .001). The average MTP joint space improved from 2.2 to 2.3 degrees (P = .001). The radiographic measurements were unchanged, except anatomic angles related to phalangeal dorsiflexion. The average width of the bone wedge was 3.5 (range, 2.2-5.0) mm, and significant correlation was found with final AOFAS score (P = .006) and pain VAS (P = .001). There were 2 revisions for screw irritation.
  
  
  CONCLUSIONS
  Phalangeal osteotomy was a reliable and reproducible treatment for moderate hallux rigidus in active patients, with substantial improvement in AOFAS score and MTP dorsiflexion and decreased pain.
  
  
  METHODS
  Level IV, prospective case series.
authors.affiliation: Foot Unit, Orthopaedic Surgery Department, Elda University Hospital, Alicante, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Perez-Aznar
authors.affiliation: Foot Unit, Orthopaedic Surgery Department, Elda University Hospital, Alicante, Spain lizaur1@telefonica.net.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lizaur-Utrilla
authors.affiliation: Orthopaedic Surgery Department, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Lopez-Prats
authors.affiliation: Unit of Clinical Investigation, Elda University Hospital, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gil-Guillen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D050277:Toe Phalanges / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: hallux rigidus; phalangeal osteotomy