Affiliation:
1. Carolinas Medical Center, Charlotte, North Carolina.
2. Miller Orthopaedic Clinic, Charlotte, North Carolina.
Abstract
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 radio-graphic 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°, to 39°, and the average range of motion improved from 34° to 64°. 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.
Subject
Orthopedics and Sports Medicine,Surgery
Reference7 articles.
1. 1. DuVries H.L. (ed.): Surgery of the Foot. St. Louis, MO, C.V. Mosby, 1959, pp. 346–421.
2. 2. Easley M.E., Anderson R.B.: Hallux rigidus in the adult and adolescent. In Disorders of the Great Toe. Adelaar R. (ed.), Rosemont, IL, 1997, American Academy Orthopaedic Surgeons, pp. 23–32.
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