Outcome of Distal First Metatarsal Osteotomy Shortening in Hallux Rigidus Grades II and III

Abstract

Background: Existing techniques for operative treatment of hallux rigidus commonly combine skeletal and soft tissue interventions to obtain long-lasting relief of pain. To date, operative treatments include implant arthroplasty, cheilectomy, various osteotomies, nonimplant arthroplasty, and arthrodesis. We assessed a technique that respects the anatomy and joint function and used a shortening osteotomy of the head of the first metatarsal. Methods: We evaluated a series of 40 consecutive patients affected by grade II and III hallux rigidus, aged 32 to 79 years, who had undergone surgery from January 2010 to January 2014. All patients were evaluated clinically and radiographically, preoperatively and postoperatively, and underwent a final follow-up at a mean of 35.4 (range = 12-51) months. For the clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal joints was used. Results: A patient survey revealed excellent and good overall satisfaction in 90% of the sample. Postoperative results included a significant increase ( P < .001) in the median global AOFAS score, from 39 (range = 25-60) to 84 (range = 78-94). Conclusions: The technique of a shortening osteotomy of the first metatarsal head appeared to be useful for the correction of stiffness, pain relief, and an improvement in range of motion. Other advantages were that it preserved the integrity of the metatarsophalangeal joint and led to a rapid functional recovery. Level of evidence: Level IV, retrospective case series.