Intermediate to long-term follow-up of medial-approach dorsal cheilectomy for hallux rigidus

Dorsal cheilectomy of the hallux metatarsophalangeal (MTP) joint through a medial approach can effectively provide long-term relief of pain and improv e function in symptomatic mild-to-moderate hallux rigidus, despite progress ion of generalized first MTP joint arthritic degeneration and/or loss of mo tion, Fifty-seven patients (75 feet) with arthritis of the first MTP joint underwent dorsal cheilectomy through a medial approach for hallux rigidus f ailing nonoperative management, Excision of the dorsal articular surface of the first metatarsal head and dorsal osteophytes was performed through a m edial approach that also allowed for plantar capsular release and removal o f lateral osteophytes, Minimum follow-up was 3 years (average, 63 months; r ange, 37-92 months). Fifty-two patients (68 feet) returned for clinical and radiographic evaluation. American Orthopaedic Foot and Ankle Society Hallu x Rating scores improved from a preoperative average of 45 to 85 points at follow-up. Average dorsiflexion improved from 19 degrees to 39 degrees, and the average range of motion improved from 34 degrees to 64 degrees, Preope rative radiographic grade of arthritic degeneration was grade I in 17 feet, grade II in 39 feet, and grade III in 12 feet; at follow-up, the radiograp hic grade was grade I in 2 feet, grade II in 26 feet, and grade III in 40 f eet, Thirty-two feet worsened one grade, 6 feet worsened two grades, and 28 feet demonstrated no change (12 of 28 were grade III, preoperatively). A d orsal spur recurred in 21 feet, 9 of which were symptomatic. Complications included two superficial wound infections and four transient paresthesias o f the hallux, all of which resolved uneventfully.