Surgical treatment of grade-3 hallux rigidus, joint-sparing approach and long-term results

Abstract

Introduction Hallux rigidus (HR) is the second most common disease of the great toe affecting the first metatarso-phalangeal joint (MTPJ) and is characterized by a painful and stiff joint. Cheilectomy is considered the gold standard treatment for early stages of HR. The objective of the study was to evaluate the functional results of cheilectomy as a standalone procedure or in conjunction with great toe proximal phalangeal osteotomy (P1) and/or first metatarsal osteotomy (M1) performed for patients with grade-3 HR according to the Coughlin and Shurnas classification. Material and methods The study included retrospective review of 17 patients (20 feet) with grade 3 HR using the Coughlin and Shurnas Grading Scale who underwent operative treatment between September 2010 and January 2017. The patients' mean age was 52 years (range, 39 to 66 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 4.5 to 7.5 years). Outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as excellent in 90 % of the cases (18/20) and good in 10 % (2/20) with neither fair nor poor results recorded. The median AOFAS score increased from preoperative 60.0 points to postoperative 97.0 points that was statistically significant (p < 0.05). Postoperative median FAAM Activities of Daily Living (ADL) and median subjective ADL was 100 %, median FAAM sport was 97 %, and median subjective sport was 90 %. Patient subjective assessment was scored as excellent in 60 % of cases (12/20), good in 40 % (8/20) with neither fair nor poor results recorded. The median VAS pain score decreased from 6 points at baseline to 1 point postsurgery (p < 0.05). Measurement of the first MTP dorsiflexion showed statistically significant increase in the median angle from 10° at baseline to 40° postsurgery (p < 0.05). Conclusion Cheilectomy as a standalone procedure or in conjunction with P1 osteotomy and/or M1 osteotomy has demonstrated 100% positive long-term outcomes for patients with Coughlin and Shurnas grade-3 HR. The procedure can be advocated as a predictable and excellent option for the cohort of patients. First MTPJ decompression is to be considered with P1 osteotomy and/or M1 osteotomy for grade-3 HR patients in preoperative planning to ensure normal forefoot anatomy and can be an option for some cases of Coughlin and Shurnas grade-3 HR.

Keywords

• hallux rigidus
• first metatarsophalangeal joint osteoarthritis
• cheilectomy
• great toe proximal phalangeal osteotomy
• first metatarsal osteotomy