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Treatment of Advanced Stages of Hallux Rigidus with Cheilectomy and Proximal Phalangeal Osteotomy
Surgical Technique
Andrew J. Elliott, MD; Stephanie C. Sayres, BS; Martin J. O’Malley, MD

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 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 Indications

Contraindications

Pitfalls & Challenges

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).

Hallux rigidus (degenerative arthritis of the first metatarsophalangeal joint) has an unknown etiology, and proposed theories include trauma, an elevated first ray, an abnormally long first ray, and a genetic predisposition for flattening of the metatarsal head4,5. Surgical management includes joint reconstructive procedures such as cheilectomy, metatarsal osteotomy, and phalangeal osteotomy as well as joint salvage procedures that include arthrodesis, interpositional arthroplasty, resection arthroplasty, and implant arthroplasty5-8. The authors of some studies have concluded that patients …


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