The modified Hohmann osteotomy: an alternative joint salvage procedure for hallux rigidus

The purpose of this study was to evaluate the effectiveness of the modified Hohmann osteotomy for treatment of hallux rigidus. By allowing plantarflexion of the first metatarsal head, this osteotomy was theorized to protect gliding motion and to decompress the joint. Twenty-two patients (25 procedures) were assessed preoperatively and postoperatively for the first metatarsal plantarflexory osteotomy. The average postoperative follow-up was 12 months, with a range of 6 to 60 months. Postoperative subjective patient questionnaires showed the following: 96% reported excellent subjective ratings with no fair or poor ratings, 80% reported a return to normal activity within 1 to 2 months, no patients reported any significant limitations in their activity or reoccurrence of pain, and no patients reported any need for a revision surgery other than hardware removal. A goniometer was used to measure preoperative and postoperative dorsiflexion and plantarflexion at the first metatarsophalangeal joint. The patient first metatarsophalangeal joint dorsiflexion increased from a mean 17.76 degrees preoperatively to a mean 58.92 degrees postoperatively. The ability to hold a piece of paper under the hallux for purchase power was also evaluated. Only 2 of 25 procedures lacked the purchase power to effectively hold a piece of paper with the hallux. Thus, the modified Hohmann osteotomy provides an excellent alternative joint-salvaging procedure for moderate to severe hallux rigidus.