OBJECTIVE: With this joint-preserving procedure impinging and damaged parts of the first metatarsal head and the proximal phalanx are removed. The attachment of the short flexor tendon is preserved. Joint motion will increase and joint function is preserved. INDICATIONS: Hallux rigidus stage 2-3 according to the Vanore classification. Salvage procedure for failed arthroplasty of the first metatarsophalangeal joint. CONTRAINDICATIONS: Hallux rigidus stage 4 according to the Vanore classification. Severe elevatus position of first ray. SURGICAL TECHNIQUE: Surgery with tourniquet is preferred. Dorsomedial skin incision. Longitudinal incision of the capsule. Removal of medial and lateral osteophytes both from the metatarsal and the proximal phalanx. Release of the sesamoids. Removal of the dorsal osteophytes from the metatarsal head and the proximal phalanx in a 45 degrees angle. Intraoperative dorsiflexion should be at least 75 degrees. Hourglass tightening of the capsule at joint level. POSTOPERATIVE MANAGEMENT: Active and passive exercises immediately after surgery. Full weight bearing is allowed. Tape in forefoot pronation if marked relieving posture. RESULTS: Follow-up study of 162 patients. Follow-up period at least 2 years (24-38 months). Increase in dorsiflexion by 27 degrees. 80% of the patients temporarily showed pain at the sesamoids. Twelve patients with progression of the osteoarthritis underwent implant arthroplasty of the first metatarsophalangeal joint (n = 10) or a fusion of the joint (n = 2) as salvage surgery. Fusion or implant arthroplasty of the first metatarsophalangeal joint could be avoided primarily. In comparison to the relevant literature the results are superior to a cheilectomy.
OBJECTIVE: With this joint-preserving procedure impinging and damaged parts of the first metatarsal head and the proximal phalanx are removed. The attachment of the short flexor tendon is preserved. Joint motion will increase and joint function is preserved. INDICATIONS: Hallux rigidus stage 2-3 according to the Vanore classification. Salvage procedure for failed arthroplasty of the first metatarsophalangeal joint. CONTRAINDICATIONS: Hallux rigidus stage 4 according to the Vanore classification. Severe elevatus position of first ray. SURGICAL TECHNIQUE: Surgery with tourniquet is preferred. Dorsomedial skin incision. Longitudinal incision of the capsule. Removal of medial and lateral osteophytes both from the metatarsal and the proximal phalanx. Release of the sesamoids. Removal of the dorsal osteophytes from the metatarsal head and the proximal phalanx in a 45 degrees angle. Intraoperative dorsiflexion should be at least 75 degrees. Hourglass tightening of the capsule at joint level. POSTOPERATIVE MANAGEMENT: Active and passive exercises immediately after surgery. Full weight bearing is allowed. Tape in forefoot pronation if marked relieving posture. RESULTS: Follow-up study of 162 patients. Follow-up period at least 2 years (24-38 months). Increase in dorsiflexion by 27 degrees. 80% of the patients temporarily showed pain at the sesamoids. Twelve patients with progression of the osteoarthritis underwent implant arthroplasty of the first metatarsophalangeal joint (n = 10) or a fusion of the joint (n = 2) as salvage surgery. Fusion or implant arthroplasty of the first metatarsophalangeal joint could be avoided primarily. In comparison to the relevant literature the results are superior to a cheilectomy.