Return to sport after osteotomy in patients with hallux rigidus

Hallux rigidus (HR) is a common degenerative condition of the first metatarsophalangeal joint (MTPJ), particularly limiting in active adults and athletes. While joint-sacrificing procedures such as arthrodesis are effective, joint-preserving techniques remain preferable in patients wishing to maintain function and mobility. The modified Youngswick osteotomy offers such an option by decompressing and realigning the joint.

This retrospective observational study included 55 physically active patients (mean age: 42.8 ± 8.5 anni years) with grade II HR who underwent modified Youngswick osteotomy between 2015 and 2022. Inclusion criteria included active engagement in sports, age under 60 years, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), the European Foot and Ankle Society (EFAS) score, and return to sports (RTS) rates.

At a mean follow-up of 79.3 months, 49 of 52 patients (94.2 %) resumed sports activities. Significant improvements were observed in VAS scores (from 5.04 to 0.9, p < .001) and EFAS general (22.7 ± 6.1-37.1 ± 5.4, p < .001) and sport-specific scores (9.3-14.3, p < .001). Postoperative dorsiflexion improved from a mean of 24.5° to 52.5° (p < .001). Complications were rare and mild, including two cases of transfer metatarsalgia and one hardware intolerance.

Modified Youngswick osteotomy is an effective joint-preserving surgical option for moderate HR in active adults. It provides excellent pain relief, improves function and range of motion, and allows for a high rate of return to sports. This technique represents a valid alternative to arthrodesis in patients wishing to maintain MTPJ mobility and an active lifestyle.