Treatment of Advanced Stages of Hallux Rigidus with Cheilectomy and Proximal Phalangeal Osteotomy: Surgical Technique.

Overview

INTRODUCTION: We believe that a combination of cheilectomy and proximal phalangeal osteotomy can be used successfully (with an 85% satisfaction rate¹) in patients with advanced hallux rigidus, including those in whom it is classified as Hattrup and Johnson² Grade III or as Coughlin and Shurnas³ Grade III or IV (extensive degeneration of the joint involving >50% of the articular surface). STEP 1 SURGICAL APPROACH: Begin with a dorsal approach to the first metatarsophalangeal joint and phalanx. STEP 2 CHEILECTOMY: Remove osteophytes and the dorsal third of the first metatarsal head. STEP 3 PROXIMAL PHALANGEAL OSTEOTOMY: Perform a 3-mm dorsal-based closing-wedge osteotomy of the proximal phalanx. STEP 4 CLOSURE AND POSTOPERATIVE PROTOCOL: Close the metatarsophalangeal joint capsule and skin. RESULTS: We reviewed the results in eighty-one patients with advanced hallux rigidus who were treated with a combination of cheilectomy and proximal phalangeal osteotomy. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.