Long term outcomes following a decompressional and plantarflexory osteotomy for hallux rigidus: A radiographical and clinical analysis.

Abstract

Although numerous surgical options have been described for the treatment of hallux rigidus, there remains no consensus regarding an optimal approach, particularly for joint-preserving procedures. The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of a plantarflexory-shortening first metatarsal osteotomy for the treatment of hallux rigidus. Long-term radiographic outcomes served as the primary endpoint and were available for 93 patients (105 feet) with a minimum follow-up of seven years. Radiographic parameters included first metatarsophalangeal (MTP) joint space, metatarsal protrusion distance, metatarsus primus elevatus, first metatarsal declination angle, and first metatarsal length, measured preoperatively and at final follow-up. A subset of 25 patients (31 feet) returned for long-term clinical evaluation of first MTP joint range of motion. Radiographic analysis demonstrated including increased second metatarsal protrusion distance (1.89 ± 1.78 mm preoperatively vs. 6.86 ± 1.23 mm at final follow-up; p < 0.0001), decreased metatarsus primus elevatus (11.65 ± 5.30° vs. 1.93 ± 4.01°; p < 0.0001), increased first metatarsal declination angle (17.68 ± 3.67° vs. 22.97 ± 3.73°; p < 0.01), and improved first MTP joint space (1.14 ± 1.23 mm vs. 1.97 ± 1.27 mm; p = 0.001). In the clinical subset, total first MTP joint range of motion improved from 27.6 ± 14.1° to 67.3 ± 14.1°, with dorsiflexion improving from 13.2 ± 8.1° to 46.1 ± 14.3°. A plantarflexory-shortening first metatarsal osteotomy provides durable, long-term radiographic correction while preserving first MTP joint motion, with low rates of reoperation.