Treatment of hallux rigidus with cheilectomy using a dorsolateral approach.

Abstract

Degenerative arthritis of the hallux metatarsophalangeal (MTP) joint can be treated in a variety of ways depending on the severity of the disease. If nonoperative treatment fails, then surgical treatment of Stage I and II has traditionally been cheilectomy. The purpose of this paper was to determine the potential advantages of cheilectomy using a less conventional dorsolateral approach. Twenty feet in 20 patients were included in the study with an average age of 53.8 (range, 29 to 69) years. The average followup was 2.8 years. Patient charts and radiographs were reviewed to determine preoperative patient characteristics and clinical-radiographic stage. All patients who qualified for the study were asked to return for evaluation using clinical examination, radiographs, and the AOFAS outcome score. Comparisons were made between preoperative and postoperative values using appropriate statistical analysis. The mean AOFAS score improved from 53.5 to 84.0 (p < 0.001). The mean range of motion arc improved from 45 to 58 degrees (p < 0.001). Clinical-radiographic stage progressed in 50%. The most common complication was numbness in the first web space (40%). This loss was imperceptible in all patients until asked during the exam. No patients progressed to fusion during the followup period. Using a dorsolateral approach to perform a cheilectomy is a viable alternative to the more traditional dorsal technique. No obvious advantage over the traditional technique was identified.