Treatment of Advanced Stages of Hallux Rigidus with Cheilectomy and Phalangeal Osteotomy

Background: Surgical treatment of hallux rigidus has usually consisted of cheilectomy for mild to moderate disease and arthrodesis for more advanced disease. The reported failure rate for cheilectomy alone in patients with advanced disease is approximately 37.5%. We reported our results with the combination of cheilectomy and extension osteotomy at the proximal phalanx for the treatment of advanced hallux rigidus. Methods: Between 2000 and 2007, eighty-one patients with advanced hallux rigidus (classified as Hattrup and Johnson Grade HI) underwent a unilateral cheilectomy and great toe proximal phalangeal extension osteotomy. Outcome assessment was determined by comparison of preoperative and postoperative American Orthopaedic Foot & Ankle Society scores, radiographs, first metatarsophalangeal joint motion, and patient satisfaction. Sixty-four of the eighty-one patients had complete clinical and radiographic examinations at a minimum duration of follow-up of two years. Results: The mean duration of follow-up was 4.3 years. The mean dorsiflexion of the first metatarsophalangeal joint improved significantly (p < 0.05), by 27.0 degrees, from 32.7 degrees preoperatively to 59.7 degrees postoperatively. The average American Orthopaedic Foot & Ankle Society scores improved significantly (p <0.05) from 67.2 points preoperatively to 88.7 points postoperatively. Radiographs of the interphalangeal joint made postoperatively showed no evidence of development of interphalangeal joint arthritis. Of the eighty-one patients, sixty-nine (85.2%) were satisfied with the results of treatment and four (4.9%) subsequently underwent arthrodesis to treat persistent symptoms at the first metatarsophalangeal joint. Conclusions: To our knowledge, this study is the first to support the use of a combination of cheilectomy and extension osteotomy of the great toe proximal phalanx as an alternative to first metatarsophalangeal joint arthrodesis to manage patients with advanced hallux rigidus.