A plantar-flexor-shortening osteotomy for hallux rigidus: a retrospective analysis

This retrospective study reported the clinical and radiographic findings of a plantar-flexor-shortening first metatarsal osteotomy for treatment of hallux rigidus. Twenty-six patients (33 feet) were evaluated with a mean 34.4 months follow-up (range, 18-65 months). Assessment consisted of clinical measurements of total range of first metatarsophalangeal joint motion and radiographic measurements of first metatarsophalangeal joint space, including plantarflexion and shortening of the first metatarsal. Patients were evaluated postoperatively using the American Orthopedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal Scoring System. The mean preoperative first metatarsophalangeal joint total range of motion was 33.5 degrees (5 degrees -60 degrees ), and postoperatively increased to 72.1 degrees (50-100 degrees ), a mean increase of 38.6 degrees at follow-up (range, 25 degrees -60 degrees ) (P < .001). This range of motion was observed despite a lack of significant improvement in radiographic joint space measurements, (preoperative mean 1.26; postoperative mean 1.82). Postoperative radiographs also demonstrated 1-4 mm of plantarflexion of the first metatarsal head, and a mean 6.1 mm shortening of the first metatarsal. At last follow-up, 85% (22/26) of patients rated their result as very good to excellent, 8% (2/26) reported a good result, 4% (1/26) a fair result, and 4% (1/26) a poor result. The mean postoperative rating scale score was 78.1/100. No patient required revisional surgery for hallux rigidus. Four patients had postoperative lesser metatarsalgia, 3 of which were self-limiting, and one that resolved following surgery. The results of this study show the plantar-flexor-shortening first metatarsal to be an effective surgical treatment for hallux rigidus with reproducible deformity correction and patient satisfaction.