Analysis of modified oblique Keller procedure for severe hallux rigidus

Several procedures have been described for treating hallux rigidus, but all have limitations. The purpose of this study is to evaluate the clinical and radiologic results of a modified oblique Keller procedure for treating hallux rigidus.

Eleven patients (13 feet) with Grade III or IV hallux rigidus were treated by modified oblique Keller procedure. Average age was 64.7 years and followup was 27.2 months. Outcomes including range of motion (ROM) of first metatarsophalengeal joint, complications, American Orthopaedic Foot and Ankle Society (AOFAS) scores, satisfaction, osteophyte recurrence, osteonecrosis, and shortening were analyzed. Preoperative and postoperative values were statistically compared.

Mean preoperative and postoperative ROMs were 6.5 degrees and 51.9 degrees, respectively (p < 0.005). Two feet had numbness on the dorsum of the first toe. Transfer metatarsalgia occurred in one patient. Mean preoperative and postoperative AOFAS scores were 29.1 points and 93.6 points, respectively (p < 0.005). All patients had good or excellent results. There was no recurrence of the dorsal osteophyte. One patient had radiographic mottling of the first metatarsal head. Average preoperative and postoperative first toe length was 124.3 mm and 123.1 mm, respectively.

This technique was a good treatment alternative for patients with end-stage hallux rigidus. It was a safe and reliable procedure that preserved range of motion and has good outcomes.