Hallux rigidus with an increased or equal first metatarsal length after a cheilectomy and first metatarsal shortening osteotomy (FMSO) using a small shortening scarf: A retrospective 7-year clinical and gait analysis follow-up.

Abstract

In hallux rigidus, the relative length of the first metatarsal has been implicated in its pathogenesis, suggesting a potential benefit from combined surgical approaches. To evaluate the long-term outcomes of a combined surgical approach using cheilectomy and shortening SCARF osteotomy for moderate hallux rigidus (Coughlin grades 2-3) in active patients with a first metatarsal index equal to or longer than the second metatarsal. Retrospective cohort study. Twenty-three feet in 20 patients (mean age 49.4 ± 8.4 years) underwent combined cheilectomy and 4-mm shortening SCARF osteotomy. Outcomes were assessed at a mean follow-up of 6.7 ± 2.5 years using the American Orthopedic Foot and Ankle Society and European Foot and Ankle Surgery scores, range of motion, and gait analysis. American Orthopedic Foot and Ankle Society scores improved from 32.2±11.7 preoperatively to 86.6±6.2 at the follow-up, and European Foot and Ankle Surgery scores increased from 13.8±2.8 perioperatively to 35.4±3.9 at the follow-up. The total range of motion increased from 32.8° to 44.7° ±16,3°. Gait analysis revealed a physiological plantar pressure distribution at follow-up. Complications included the recurrence of joint stiffness and pain in three patients and transient transfer metatarsalgia in one patient. Shortening SCARF osteotomy plus mild cheilectomy may be an effective joint-preserving procedure in patients with first metatarsal overlength, with results comparable to those of cheilectomy and other first metatarsal shortening osteotomies.