Surgery for hallux rigidus

NewsBot · Nov 17, 2022

Does Sesamoid Pathology Adversely Impact Outcomes of Cheilectomy in the Treatment of Hallux Rigidus?
Rohan A. Gheewala, MD, Olivia J. Bono, and Andrew J. Rosenbaum, MDView all authors and affiliations
SOurce

Introduction/Purpose:
Hallux rigidus (HR) is the most common degenerative pathology of the foot, marked by degenerative osteoarthritis of the first metatarsophalangeal joint (MTPJ) and reduced sagittal motion. Cheilectomy remains the standard of treatment, with satisfactory pain relief and increases in MTPJ range of motion (ROM). While the majority of these patients have satisfactory outcomes, a subset remains dissatisfied with persistent pain and poor ROM. In this study, we aim to assess the effect of sesamoid pathology on the functional outcomes of those undergoing cheilectomy for hallux rigidus.
Methods:
Electronic medical records were retrospectively reviewed to identify patients who underwent cheilectomy, with or without a corrective osteotomy (Moberg or Akin) for a diagnosis of HR, identified through CPT code 28289. The data referenced was from November 2019 through November 2021, belonging to three fellowship-trained foot and ankle specialists at a single high volume orthopedic practice. Exclusion criteria included revision procedures, loss of follow-up prior to one year, and prior sesamoidectomy. Our assessment included the presence of sesamoid arthritis or degeneration, demographic data, stage of HR according to the Coughlin and Shurnas classification on preoperative plain radiographs, a patient-reported pain scale, postoperative satisfaction, ROM, and return to activity. Patients were followed at 6 weeks, 3 months, 6 months, and 1 year.
Complications were recorded. Statistical analysis was performed using Pearson's chi-square analysis and a two-sample t-test with significance set at alpha <0.05.
Results:
In this retrospective study, 74 patients who underwent cheilectomy for the treatment of hallux rigidus were examined; 1 with grade 0 HR, 7 with grade 1 HR, 51 with grade 2 HR, and 15 with grade 3 HR. There were 33 with radiographic evidence of sesamoid arthritis, 41 without. Those with sesamoid arthritis trended towards having less pain relief over the course of our study (p=0.290) and more restricted postoperative ROM (p=0.385), though neither reached significance. There was no difference in complication rates between the two groups (p=0.661).
Conclusion:
The presence of sesamoid pathology appears to trend towards worse outcomes after cheilectomy for the treatment of hallux rigidus. Patients with sesamoid pathology may go unrecognized and may warrant consideration for modalities of treatment beyond cheilectomy for hallux rigidus for more satisfactory outcomes. This study is limited in its power and would benefit from greater sample sizes and more objective parameters of measurement. Nonetheless, this data allows for recognition of these patients in whom cheilectomy does not result in pain relief with the goal of identifying factors to improve care and provide sufficient treatment.
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NewsBot · Nov 21, 2022

A Patient-Reported Outcome Based Comparison of Cheilectomy with and without Proximal
Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus
Rami Mizher; Robert Fuller; Jaeyoung Kim, MD; Lavan Rajan, BA; Agnes D. Cororaton; Prashanth Kumar; Tonya W. An, MD;
Jonathan T. Deland, MD; Scott J. Ellis, MD
AOFAS Annual Meeting 2022

Introduction/Purpose: Cheilectomy with and without Moberg osteotomy is used to improve function and remove pain in earlymoderate stage hallux rigidus. The rise of patient-reported outcome measurements allows greater precision in comparing
treatments as value-driven paradigms become increasingly important in clinical decision-making. This study provides the first
comparison of patient-reported outcomes between isolated cheilectomy (C) and cheilectomy with Moberg (CM) osteotomy for
hallux rigidus. We compared one and two-year PROM scores between patients who underwent C and CM for hallux rigidus using
PROMIS, a validated patient-reported outcomes measurement system, and compared rates of complications and subsequent
operations between the two groups. We hypothesized that patients who underwent CM would experience better clinical
outcomes and fewer returns to the operating room than patients undergoing cheilectomy alone.
Methods: A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent
cheilectomy, with and without concomitant proximal phalangeal dorsiflexion osteotomy, for hallux rigidus between January 2016
and December 2020. An a priori power analysis determined that 24 patients per cohort were needed to detect a previously
published minimum clinically important difference of 5.8 points on the PROMIS Physical Function scale with alpha = .05 and 80%
power. However, all C patients were included. Because there were far fewer isolated cheilectomies (62), all C patients were
compared with a commensurate number of consecutive CM cases (67) using preoperative, one-year, and two-year PROMIS
scores for Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression, as
well as complication and revision data from chart review. Age, sex, BMI, preoperative radiographic hallux rigidus grade, and
preoperative range of motion were compared between the two cohorts.
Results: PROMIS outcome data is given in Table 1. Both groups demonstrated statistically significant improvements in PROMIS
Physical Function, Pain Interference, Pain Intensity, and Global Physical Health (P <.001 for all, both preoperative to one-year and
preoperative to two-year), but not Global Mental Health or Depression. There were no differences between groups among the
demographic and preoperative variables compared. The CM cohort reported worse Pain Interference scores preoperatively (58.1
+- 5.9 vs. 52.4 +- 7.01, P < .001) and at one year (50.0 +- 9.3 vs. 45.1 +- 9.8, P = .01), while the C cohort reported worse Pain
Intensity scores preoperatively (55.6 +- 7.3 vs. 49.6 +- 6.8, P < .001) and at one year (45.9 +- 8.0 vs. 39.9 +- 8.2, P < .001). These
differences were no longer significant at two years postoperatively. There were no statistically significant differences between
cohorts for additional PROMIS scores or complications data.
Conclusion: The addition of a Moberg osteotomy does not appear to significantly change short-medium term outcomes of
cheilectomy for hallux rigidus treatment. Our data contradicts the notion that addition of a Moberg osteotomy increases the
likelihood of postoperative complications. The overall good results found for both procedures, as well as the general similarity
between outcomes between them, suggest that external considerations like recovery time, comfort level with a more invasive
osteotomy, and overall goals with surgery may be of greater importance than short-term clinical outcomes when deciding on the
appropriate course of treatment for a given patient.
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NewsBot · Nov 22, 2022

First Metatarsophalangeal Arthrodesis Outcomes of Hallux Rigidus vs Hallux Valgus
Warren J. Roth, Caroline P. Hoch, […], and Daniel J. Scott, MD, MBA
Source

Introduction/Purpose:
First metatarsophalangeal (MTP) joint arthrodesis is a commonly performed surgical procedure for patients with hallux rigidus (HR) or severe hallux valgus (HV). The purpose of this study was to compare patient outcomes of 1st MTP arthrodesis between HR and HV cohorts. We hypothesized that there would be no difference in patient-reported outcome measures (PROMs) or complication rates between groups.
Methods:
A retrospective review was conducted at a single academic medical center of patients who underwent 1st MTP arthrodesis with one of two fellowship-trained foot and ankle orthopaedic surgeons between 2009 and 2021. A total of 136 patients (148 feet: HR=75, HV=47, both=44) met the inclusion criteria of the three-month follow-up minimum. Data collection included PROMs (i.e., Visual Analogue Scale [VAS], 12-item Short Form Survey [SF-12], Foot and Ankle Outcome Score [FAOS], and Foot and Ankle Ability Measure [FAAM], Patient-Reported Outcomes Measurement Information System [PROMIS]), radiographic markers, and complication and reoperation rates. The VAS, SF-12, FAOS, and FAAM were collected preoperatively; the FAOS and FAAM were collected postoperatively; and all were collected via prospective phone interview. Forty-six patients (50 feet: HR=21, HV=15, both=14) completed the phone interview at an average of 3.04 (range, 0.58-10.01) years postoperatively. Mean clinical follow-up was 1.25 (range, 0.25-6.14) years.
Results:
The HR had a significantly smaller improvement in HVA (HR=-3.60, HV=-17.44, combined=-15.27; p<.001), IMA (HR=- 0.16, HV=-2.80, combined=-2.55; p<.001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.59, combined=-4.60; p<.001). There was a trend toward improved PROMs, although only significant for all groups with the VAS (p<.001, p<.001, p<.001), FAOS Quality of Life (p<.001, p=.030, p=.001), and FAAM Activities of Daily Living (p<.001, p=.046, p=.002) and Total (p=.001, p=.024, p=.016) scores. The HV group significantly improved among the least PROMs. (Table 1) Complication (HR=28.07%, HV=38.30%, combined=36.36%; p=.499) and reoperation (HR=14.04%, HV=25.53%, combined=20.45%; p=.334) rates did not differ by group, although both were lowest for the HR group. Superficial infection (HR=12.28%, HV=17.02%, combined=9.09%; p=.521) and nonunion (HR=17.54%, HV=10.64%, combined=13.64%; p=.599) rates also did not differ.
Conclusion:
Indication for MTP arthrodesis does not appear to influence subjective outcomes of 1st MTP arthrodesis, as only one postoperative PROM differed between cohorts. All groups trended toward PROM improvements at 1-year and 3-years postoperative, although the HR group was the only group to continue improving from 1-year to 3-years postoperative. Thus, this study begins to provide insight into the role that specific forefoot pathology plays in 1st MTP arthrodesis outcomes, as we only found radiographic measures to be significantly different.
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NewsBot · Dec 6, 2022

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus
Kepler Alencar Mendes de Carvalho et al
Foot Ankle Orthop. 2022 Nov 28;7(4)

Background: Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study's objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups.

Methods: A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test.

Results: Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05).

Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements.
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NewsBot · Jan 19, 2023

Synthetic cartilage implant hemiarthroplasty versus cheilectomy for the treatment of hallux rigidus
Tyler Hoskins et al
Eur J Orthop Surg Traumatol. 2023 Jan 18

Degenerative arthritis of the first metatarsophalangeal joint, hallux rigidus, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. Hallux rigidus can be treated surgically with either Cheilectomy or Synthetic cartilage implant (SCI) hemiarthroplasty. The purpose of this study is to compare outcomes from a single institution on the treatment of hallux rigidus using cheilectomy and SCI hemiarthroplasty. Between 2012 and 2020, 49 patients underwent either a SCI (Polyvinyl alcohol hydrogels) hemiarthroplasty or Cheilectomy for the treatment of hallux rigidus. Functional scores were assessed pre and postoperatively using the American Orthopedic Foot and Ankle scoring System (AOFAS) and the Foot and Ankle Outcome Score survey (FAOS). Plantar and Dorsal range of motion was also assessed pre and postoperatively. Outcomes, complications, and any reoperations were recorded for all patients. Mean pre-op AOFAS for Cheilectomy and SCI were 49.6 and 54.8, respectively, compared to 85.3 and 89.7, respectively, after surgery (p value < 0.05). Mean pre-op Dorsal range of motion (ROM) for Cheilectomy and SCI were 24.0 and 26.0 degrees, respectively, compared to 38.0 and 42.6 degrees, respectively, after surgery (p value < 0.05). SCI hemiarthroplasty patients had higher AOFAS and dorsal ROM at the latest follow up (p value < 0.05). Synthetic cartilage implant (SCI) hemiarthroplasty and cheilectomy both offer promising results and remain viable treatment options to decrease pain, improve function, and maintain motion for hallux rigidus. SCI hemiarthroplasty may offer superior range of motion and functional outcomes than cheilectomy for hallux rigidus
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NewsBot · Feb 3, 2023

Revision Surgery After Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single-Surgeon 5-Year Experience
Aman Chopra et al
Foot Ankle Spec. 2023 Feb 2

Background: While metatarsophalangeal joint (MTPJ) arthrodesis is regarded as the gold standard treatment option for end-stage hallux rigidus (HR), synthetic cartilage implant (SCI) resurfacing has gained popularity. This study aimed to identify the SCI resurfacing failure rate for a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing.

Methods: Health records were queried from 2016 to 2021 for patients with HR who were treated with SCI resurfacing by a single surgeon. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and hallux valgus angles were compared. A subgroup analysis was performed on patients who underwent revision with SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft, bone putty, or a custom 3D printed baseplate to prevent implant subsidence.

Results: A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When analyzing index procedures, an 8.2% revision rate was determined. The revision cohort (n = 23) consisted of 19 female patients and presented with a mean body mass index of 29.5 ± 5 kg/m2, mean age of 52.8 ± 11 years, mean follow-up duration of 22.3 (range, 3-54) months, and mean time to a revision surgery of 12.1 ± 12 (range, 1-50) months. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. While all patients experienced significant improvement in their VAS pain scores (P < .001), the arthrodesis cohort experienced a greater improvement than the SCI revision cohort (P = .04).

Conclusion: When analyzing SCI revision procedures, MTPJ arthrodesis reduced pain more significantly than SCI replacement.
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NewsBot · Feb 19, 2023

First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes
Yvonne Chodaba, MD et al
February 17, 2023

Few prior studies have compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. A retrospective review of 98 patients who a received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including non-union were collected. Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and the Foot Function Index (FFI) Revised Short Form scores were obtained via telephone. Patients were grouped based on review of preoperative radiographs of the foot and this grouping 37 hallux rigidus and 61 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. No differences in the rate of wound complications, radiographic union, and revision surgery were found between the two subgroups. At a median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. The postoperative first MTP dorsiflexion angle in the hallux rigidus group was correlated with decreased FFI Pain, FFI Total, and PROMIS Pain Interference domain scores (|r| ≥.40, p<.05 for all). When performing MTP arthrodesis in patients with hallux rigidus, increasing the first MTP dorsiflexion angle may correlate with improved intermediate term patient reported outcomes. However, further studies will need to be done to confirm this theoretical relationship.
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NewsBot · Feb 23, 2023

Cheilectomy Alone in Patients with Elevatus Yields Poor Five-Year Survival Rate
Anthony Mollica, DPM FACFAS et al
February 22, 2023

This study was performed to evaluate the efficacy of the cheilectomy procedure for different degrees of elevatus. The study was Institutional Review Board approved and patients were evaluated retrospectively at Ascension St. John Hospital, St. John Surgery Center and St. John Macomb Township Surgery Center between 9/8/2012 – 1/8/2016. These were all performed by the same surgeon. The pre and post operative radiographs were analyzed and Seiberg's index was calculated. Charts were also reviewed, and demographic information was obtained. A phone survey was performed, and Visual Analog Pain score and Foot and Ankle Ability Measure was obtained. Body mass index, age, calcaneal inclination angle, Seiberg's index, Foot and Ankle Ability Measure and visual analog score were analyzed using chi-square test, bivariate regression analysis and independent t-test. Seiberg's index had a statistically significant influence on five-year survival rate for the cheilectomy procedure (p ≤ 0.05). For patients with Seiberg's index less than 0.20 cm demonstrated FAAM, and VAS p values 0.18 and 0.37 with 87.0% five-year survival. Seiberg's index between 0.20 - 0.40 cm had FAAM and VAS scores with p values < 0.01 and 0.02 with 62.0% five-year survival. Seiberg's index ≤ 0.40 cm p values < 0.01 and 0.55 with five-year survival rate of 0.0%. Therefore, if Seiberg's index is greater than 0.20 cm based on this research a cheilectomy alone as a sole treatment is at greater risk of failure.
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NewsBot · Feb 28, 2023

Coughlin grade III hallux rigidus: comparison between distal oblique sliding osteotomy and arthrodesis
Gianni CAIZZI et al
Minerva Orthopedics 2023 February;74(1):20-7

BACKGROUND: Osteoarthritis of the first metatarsophalangeal joint (hallux rigidus) is the most common degenerative joint pathology of the foot and it is characterized by pain, functional limitation, and radiographic degenerative joint disease. This study aimed to compare the clinical outcomes between arthrodesis and distal oblique sliding osteotomy (DOSO) in patients with hallux rigidus grade 3 according to Choughlin and Shurnas Scale. We hypothesized the DOSO superiority on pain reduction and improvement in quality of life.
METHODS: Sixty-six patients (mean age 57.53), with unilateral first metatarsophalangeal joint arthritis, were recruited from January to July 2020 and randomly selected to have arthrodesis or DOSO. Thirty-six patients were treated with arthrodesis and 30 patients with DOSO. A single surgeon performed all surgery. Functional outcomes: The American Orthopedic Foot and Ankle Score (AOFAS) and Visual Analogic Scale (VAS) were assessed before surgery, at 3 months and at 6 months.
RESULTS: The mean age of the recruited patients was 57.53±7.56 years. VAS scores differed significantly between the two groups at 6 months after surgery (P value <0.0001). AOFAS scores, instead, differed significantly before surgery and tend to get closer in subsequent outpatient visit (P value <0.0001).
CONCLUSIONS: In Coughlin grade III hallux rigidus, DOSO is a safe and effective technique with good results in terms of pain and ROM recovery and certainly a less invasive technique than the classic arthrodesis.
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NewsBot · Mar 14, 2023

Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review
Wout Füssenich et al
EFORT Open Rev. 2023 Mar 14;8(3):101-109

Purpose: A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.

Material and methods: A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.

Results: Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.

Conclusion: Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.
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NewsBot · Mar 27, 2023

Cheilectomy Alone in Patients With Elevatus Yields Poor 5-Year Survival Rate
Anthony Mollica et al
J Foot Ankle Surg. 2023 Feb 23

This study was performed to evaluate the efficacy of the cheilectomy procedure for different degrees of elevatus. The study was Institutional Review Board approved and patients were evaluated retrospectively at Ascension St. John Hospital, St. John Surgery Center and St. John Macomb Township Surgery Center between 9/8/2012 and 1/8/2016. These were all performed by the same surgeon. The pre- and postoperative radiographs were analyzed and Seiberg's index was calculated. Charts were also reviewed, and demographic information was obtained. A telephone survey was performed, and Visual Analog Pain score and Foot and Ankle Ability Measure was obtained. Body mass index, age, calcaneal inclination angle, Seiberg's index, Foot and Ankle Ability Measure, and visual analog score were analyzed using chi-square test, bivariate regression analysis and independent t test. Seiberg's index had a statistically significant influence on 5-year survival rate for the cheilectomy procedure (p ≤ .05). For patients with Seiberg's index less than 0.20 cm demonstrated FAAM, and VAS p values .18 and .37 with 87.0% 5-year survival. Seiberg's index between 0.20 and 0.40 cm had FAAM and VAS scores with p values <.01 and .02 with 62.0% 5-year survival. Seiberg's index ≤0.40 cm p values <.01 and .55 with 5-year survival rate of 0.0%. Therefore, if Seiberg's index is greater than 0.20 cm based on this research a cheilectomy alone as a sole treatment is at greater risk of failure.
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NewsBot · Mar 28, 2023

Association of First Metatarsal Phalangeal Joint Fusion for Hallux Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking Psychotropic Medications
Wesley J Manz et al
Foot Ankle Orthop. 2023 Mar 22;8(1)

Background: Limited literature examines the relationship between surgical outcomes in chronic foot and ankle conditions and concurrent psychiatric care. The present study aimed to investigate patient-reported and surgical outcomes of patients treated for a psychiatric disorder undergoing first metatarsophalangeal (MTP) fusion for hallux rigidus. We hypothesized that patients on psychotropic medications would have greater subjective pain preoperatively and less improvement in physical and mental functionality postoperatively when compared with nonmedicated patients.

Methods: A single-center, retrospective review of prospectively collected data was conducted on 92 patients undergoing first MTP fusion with a preoperative diagnosis of hallux rigidus from 2015 to 2019. At their preoperative, 6-month postoperative, and 1-year postoperative visits, patients were administered visual analog pain scale (VAS) and 36-Item Short Form Health Survey (SF-36) functionality surveys. Patients were subsequently identified by chronic use of psychotropic medication preoperatively and grouped for analysis (MED, n = 42; NO MED, n = 50).

Results: Postoperative mean VAS pain scores were lower for all studied patients at 6 months (VAS = 1.6 ± 2.3) and 1 year postoperatively (VAS = 1.1± 1.8) relative to the preoperative visit (VAS = 4.7 ± 2.8) (P ≤ .0001 and P ≤ .0001, respectively). No differences in mean VAS pain scores nor SF-36 physical component summary scores were detected at preoperative, 6-month, or 1-year visits between NO MED and MED groups. Mean SF-36 mental component summary scores for those in the MED group were lower at preoperative (NO MED = 83.8, MED = 71.8, P = .006) and 6-month postoperative (NO MED = 86.1, MED = 72.7, P = .037) visits than those in the NO MED group, a trend not observed at the 1-year postoperative mark (NO MED = 84.1, MED = 76.8, P = .228). There were no observed differences in operative time (P = .219), tourniquet time (P = .359), nor time to full weightbearing (P = .512) between MED and NO MED groups. Additionally, no differences in postoperative complication rates were observed between groups.

Conclusion: In patients treated with psychotropically active medications with hallux rigidus, MTP Fusion appears to be a reasonable treatment choice with similar outcomes for patients requiring psychotropically active medications to the outcomes of those patients not requiring psychotropically active medications.
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NewsBot · Mar 30, 2023

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study
Wout Füssenich et al
Foot & Ankle International March 23, 2023

Background:
Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.
Methods:
A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.
Results:
Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.
Conclusion:
Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.
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NewsBot · Mar 30, 2023

First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes
Yvonne Chodaba et al
J Foot Ankle Surg. 2023 Feb 18

Few prior studies have compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. A retrospective review of 98 patients who a received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including nonunion were collected. Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and the foot function index (FFI) revised short form scores were obtained via telephone. Patients were grouped based on review of preoperative radiographs of the foot and this grouping 37 hallux rigidus and 61 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. No differences in the rate of wound complications, radiographic union, and revision surgery were found between the 2 subgroups. At a median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. The postoperative first MTP dorsiflexion angle in the hallux rigidus group was correlated with decreased FFI Pain, FFI Total, and PROMIS Pain Interference domain scores (|r| ≥ 0.40, p < .05 for all). When performing MTP arthrodesis in patients with hallux rigidus, increasing the first MTP dorsiflexion angle may correlate with improved intermediate term patient reported outcomes. However, further studies will need to be done to confirm this theoretical relationship.
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NewsBot · Apr 3, 2023

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study
Wout Füssenich et al
Source

Background:
Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.
Methods:
A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.
Results:
Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.
Conclusion:
Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.
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NewsBot · Apr 4, 2023

Converting 1st metatarsophalangeal joint fusion to interposition arthroplasty. Mid-term results of a case series
Dimitrios Georgiannos et al
Foot (Edinb). 2023 Mar 25

Background: Fusion of the first metatarsophalangeal (MTP) joint has been considered as the gold standard for treatment of advanced hallux rigidus. The main disadvantage is the restriction of movement which may not be as favorable as anticipated by several patients. The purpose of this study was to report clinical and functional outcomes on patients who were treated with interposition arthroplasty after a 1st MTP joint fusion which had not fulfilled their expectations.

Methods: Between 2009 and 2014, 11 patients who were not satisfied by 1st MTP joint fusion for hallux rigidus, underwent a conversion to interposition arthroplasty. After removal of hardware, the fusion was taken down by removal of a bone block from the fused joint. A fascia lata graft was interposed. Intraoperative and postoperative complications, range of motion of the first MTP joint, length of first ray, and patients' satisfaction were recorded as the primary outcomes.

Results: Mean age was 34 years (range, 24-42 y). The mean ± SD AOFAS/H/MTP/IP score was 61 ± 5.5 preoperatively, 90.5 ± 4.5 at one year and 92 ± 4 at five years postoperatively (p < 0.001). The mean ± SD VAS-FA score was 91 ± 3.5 preoperatively, 94.5 ± 2.5 at one year and 95 ± 2.5 at five years postoperatively (p > 0.05). Mean ROM at the final follow-up was 58° ± 5° of dorsiflexion and 27° ± 4° of plantarflexion. No inter- or postoperative complications were encountered. The length of the hallux was decreased by a mean of 1.5 mm (range, 1-2.5 mm). All patients were satisfied with the overall outcome, walking ability and shoe-wear convenience and graded their condition as excellent (9 cases) or good (2 cases).

Conclusions: Converting a 1st MTP joint fusion to interposition arthroplasty with a fascia lata allograft could be a safe alternative with promising results in selected cases especially in relatively young and athletic population.
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NewsBot · Apr 6, 2023

Dorsal Cheilectomy Using Great Toe Metatarsophalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus
Paul M. Alvarez M.D et al
Arthroscopy Techniques 2 April 2023

Great toe metatarsophalangeal joint (MTPJ) arthroscopy has been described in the literature for more than 50 years for treatment of a multitude of first MTPJ pathologies, including hallux rigidus, hallux valgus, and osteochondritis dissecans, among others. Despite this, the use of great toe MTPJ arthroscopy has not become widely used for treatment of these conditions as the result of reported difficulties with adequate visualization of the joint surface and manipulation of surrounding soft-tissue structures with the instruments available. We propose a simple technique with illustrations of the operating room setup and procedural steps to perform a dorsal cheilectomy in those with early-stage hallux rigidus using great toe MTPJ arthroscopy and a minimally invasive surgical burr in a way that is reproducible by foot and ankle surgeons.
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NewsBot · May 14, 2023

Incidence of Nonunion of the First Metatarsophalangeal Joint Arthrodesis After Failed Implant Arthroplasty: A Systematic Review
Eric So et al
Foot Ankle Spec. 2023 May 11

Joint arthroplasty of the first metatarsophalangeal (MTP) joint is an accepted surgical option for patients with hallux rigidus. However, this procedure has been reported to have a high complication rate and unpredictable survivorship. Implant arthroplasty failure is a devastating complication that results in significant osseous defect with altered biomechanics of the foot. Commonly, salvage options are limited to arthrodesis with bone grafting. However, outcomes are rarely reported. The purpose of this study is to investigate the fusion rates of first metatarsophalangeal joint arthrodesis after conversion from failed implant arthroplasty. A systematic review of electronic databases to find reports of conversion arthrodesis after failed implant arthroplasty was performed. Six studies involving a total of 76 patients with a weighted mean age of 54.9 met the inclusion criteria. Out of the 6 included articles, the nonunion rate was 16.5% at a weighted mean follow-up of 48.1 months. The nonunion rate in the current report is higher than reported nonunion rates of primary arthrodesis. More prospective studies with consistent and standard outcome measures are needed to further determine the success rate of this salvage procedure.
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NewsBot · May 19, 2023

What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus?
Mindi Dayton, DPM, MHA, FACFAS et al
May 17, 2023

First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weight bearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity were similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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Surgery for hallux rigidus

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Joint replacement surgery for hallux rigidus

Hallux Limitus/Rigidus surgery

Gait changes following surgery for hallux rigidus

Long term follow up of hallux rigidus surgery

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

Do Patients Aged 70 Years and Older Benefit From Hallux Valgus Surgery?

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Surgery for hallux rigidus

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Joint replacement surgery for hallux rigidus

Hallux Limitus/Rigidus surgery

Gait changes following surgery for hallux rigidus

Long term follow up of hallux rigidus surgery

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

Do Patients Aged 70 Years and Older Benefit From Hallux Valgus Surgery?

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