Surgery for hallux rigidus

NewsBot · May 29, 2026

Revision First MTP Arthrodesis & Arthroplasty Using Titanium Truss Implants: Early Outcomes and Cost Comparison of Custom Versus Prefabricated Options
Madison Burandt DPM (Resident), Mary Brandt DPM, AACFAS (Faculty), Alan Catanzariti DPM, FACFAS (Program Director)
Foot & Ankle Surgery: Techniques, Reports & Cases

Bone loss following failed first metatarsophalangeal (MTP) arthrodesis or arthroplasty presents a challenging reconstructive problem requiring restoration of length and structural stability. Titanium truss implants are an alternative option to traditional bone grafting, with both custom and prefabricated options available. However, differences in costs and intraoperative adaptability between these implant types remain underreported. This report presents seven patients (eight feet) who underwent revision procedures for first MTP arthrodesis or arthroplasty using either custom or prefabricated titanium truss implants. Osseous union was confirmed radiographically or via computed tomography in all cases. Patients remained non-weight-bearing for at least seven weeks and achieved pain-free ambulation in regular shoe-gear at approximately three months postoperatively. A substantial difference in implant cost was observed, with custom titanium trusses averaging $12,700 and prefabricated titanium truss implants averaging $1,880. Titanium truss implants appear to be a viable option for revision for first MTP reconstruction. Prefabricated titanium truss implants may offer potential advantages in cost and intraoperative flexibility, particularly in cases where defect size is difficult to fully assess preoperatively.
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NewsBot · Jun 6, 2026

Long term outcomes following a decompressional and plantarflexory osteotomy for hallux rigidus: A radiographical and clinical analysis
Anthony Schwab et al
Source

Background
Although numerous surgical options have been described for the treatment of hallux rigidus, there remains no consensus regarding an optimal approach, particularly for joint-preserving procedures.
Purpose
The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of a plantarflexory-shortening first metatarsal osteotomy for the treatment of hallux rigidus.
Study Design/Methods
Long-term radiographic outcomes served as the primary endpoint and were available for 93 patients (105 feet) with a minimum follow-up of seven years. Radiographic parameters included first metatarsophalangeal (MTP) joint space, metatarsal protrusion distance, metatarsus primus elevatus, first metatarsal declination angle, and first metatarsal length, measured preoperatively and at final follow-up. A subset of 25 patients (31 feet) returned for long-term clinical evaluation of first MTP joint range of motion.
Results
Radiographic analysis demonstrated including increased second metatarsal protrusion distance (1.89 ± 1.78 mm preoperatively vs. 6.86 ± 1.23 mm at final follow-up; p < 0.0001), decreased metatarsus primus elevatus (11.65 ± 5.30° vs. 1.93 ± 4.01°; p < 0.0001), increased first metatarsal declination angle (17.68 ± 3.67° vs. 22.97 ± 3.73°; p < 0.01), and improved first MTP joint space (1.14 ± 1.23 mm vs. 1.97 ± 1.27 mm; p = 0.001). In the clinical subset, total first MTP joint range of motion improved from 27.6 ± 14.1° to 67.3 ± 14.1°, with dorsiflexion improving from 13.2 ± 8.1° to 46.1 ± 14.3°.
Conclusions
A plantarflexory-shortening first metatarsal osteotomy provides durable, long-term radiographic correction while preserving first MTP joint motion, with low rates of reoperation.
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NewsBot · Jun 7, 2026

Long term outcomes following a decompressional and plantarflexory osteotomy for hallux rigidus: A radiographical and clinical analysis
Anthony Schwab et al
J Foot Ankle Surg. 2026 Jun 5:S1067-2516(26)00153-5.

Background: Although numerous surgical options have been described for the treatment of hallux rigidus, there remains no consensus regarding an optimal approach, particularly for joint-preserving procedures.

Purpose: The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of a plantarflexory-shortening first metatarsal osteotomy for the treatment of hallux rigidus.

Study design/methods: Long-term radiographic outcomes served as the primary endpoint and were available for 93 patients (105 feet) with a minimum follow-up of seven years. Radiographic parameters included first metatarsophalangeal (MTP) joint space, metatarsal protrusion distance, metatarsus primus elevatus, first metatarsal declination angle, and first metatarsal length, measured preoperatively and at final follow-up. A subset of 25 patients (31 feet) returned for long-term clinical evaluation of first MTP joint range of motion.

Results: Radiographic analysis demonstrated including increased second metatarsal protrusion distance (1.89 ± 1.78 mm preoperatively vs. 6.86 ± 1.23 mm at final follow-up; p < 0.0001), decreased metatarsus primus elevatus (11.65 ± 5.30° vs. 1.93 ± 4.01°; p < 0.0001), increased first metatarsal declination angle (17.68 ± 3.67° vs. 22.97 ± 3.73°; p < 0.01), and improved first MTP joint space (1.14 ± 1.23 mm vs. 1.97 ± 1.27 mm; p = 0.001). In the clinical subset, total first MTP joint range of motion improved from 27.6 ± 14.1° to 67.3 ± 14.1°, with dorsiflexion improving from 13.2 ± 8.1° to 46.1 ± 14.3°.

Conclusions: A plantarflexory-shortening first metatarsal osteotomy provides durable, long-term radiographic correction while preserving first MTP joint motion, with low rates of reoperation.
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NewsBot · Jun 11, 2026

Long-term Outcomes After First Metatarsophalangeal Joint Arthrodesis: With Focus on Degenerative Changes on Adjacent Joints
Simon Recheis et al
Foot Ankle Int. 2026 Jun 10:10711007261441611.

Background: First metatarsophalangeal joint arthrodesis is a reliable treatment for painful end-stage degenerative, inflammatory, and post-traumatic conditions and severe deformities of the first ray. Although long-term functional outcomes are well documented, the incidence and relevance of degenerative changes in adjacent joints of the medial column after first metatarsophalangeal joint (MTP1) fusion remain uncertain.

Methods: This exploratory single-center follow-up study included patients who underwent isolated MTP1 arthrodesis between 2012 and 2018. Preoperative and final follow-up weight-bearing radiographs were assessed for osteoarthritis progression in the interphalangeal (IP), tarsometatarsal (TMT1), naviculocuneiform (NC), and talonavicular (TN) joints using the Kellgren-Lawrence classification. Radiographic alignment parameters (hallux valgus angle, intermetatarsal angle, hallux-ground angle, and dorsal extension angle) were recorded. Clinical outcome was evaluated using American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal score (AOFAS HMI) score, Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and a study-specific questionnaire. Paired statistical tests and Pearson correlation analyses were performed.

Results: Seventy-seven patients (45 female, 32 male) were available for follow-up at a mean of 106.9 ± 25.3 months. Radiographic osteoarthritis progression was significant in all assessed adjacent joints (P < .001) and was most pronounced in the IP joint (66 of 77 joints; 34 of 77 joints progressed by ≥2 grades). TMT1 progression occurred in 23 of 77 joints (≥2 grades in 5 of 77 joints), and NC or TN progression in 30 of 77 joints (≥2 grades: NC 6 of 77, TN 8 of 77). Radiographic alignment was not associated with adjacent-joint osteoarthritis progression, metatarsalgia, or patient-reported outcome. Overall, 90.9% reported good or excellent satisfaction. The mean AOFAS HMI score was 79.9 ± 9.1, FAOS 86.4 ± 15.2, and FFI 18.5% ± 9.3%. Wound healing complications were more frequent with dorsal plating than screw fixation. One nonunion required revision.

Conclusion: MTP1 arthrodesis provides excellent long-term satisfaction and functional outcomes with low revision rates. Although radiographic adjacent-joint degeneration, particularly involving the interphalangeal joint, may occur over time, these changes do not appear to influence clinical outcomes.
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NewsBot · Jun 15, 2026

Long-term Outcomes After First Metatarsophalangeal Joint Arthrodesis: With Focus on Degenerative Changes on Adjacent Joints
Simon Recheis et al
Source

Background:
First metatarsophalangeal joint arthrodesis is a reliable treatment for painful end-stage degenerative, inflammatory, and post-traumatic conditions and severe deformities of the first ray. Although long-term functional outcomes are well documented, the incidence and relevance of degenerative changes in adjacent joints of the medial column after first metatarsophalangeal joint (MTP1) fusion remain uncertain.
Methods:
This exploratory single-center follow-up study included patients who underwent isolated MTP1 arthrodesis between 2012 and 2018. Preoperative and final follow-up weight-bearing radiographs were assessed for osteoarthritis progression in the interphalangeal (IP), tarsometatarsal (TMT1), naviculocuneiform (NC), and talonavicular (TN) joints using the Kellgren-Lawrence classification. Radiographic alignment parameters (hallux valgus angle, intermetatarsal angle, hallux-ground angle, and dorsal extension angle) were recorded. Clinical outcome was evaluated using American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal score (AOFAS HMI) score, Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and a study-specific questionnaire. Paired statistical tests and Pearson correlation analyses were performed.
Results:
Seventy-seven patients (45 female, 32 male) were available for follow-up at a mean of 106.9 ± 25.3 months. Radiographic osteoarthritis progression was significant in all assessed adjacent joints (P < .001) and was most pronounced in the IP joint (66 of 77 joints; 34 of 77 joints progressed by ≥2 grades). TMT1 progression occurred in 23 of 77 joints (≥2 grades in 5 of 77 joints), and NC or TN progression in 30 of 77 joints (≥2 grades: NC 6 of 77, TN 8 of 77). Radiographic alignment was not associated with adjacent-joint osteoarthritis progression, metatarsalgia, or patient-reported outcome. Overall, 90.9% reported good or excellent satisfaction. The mean AOFAS HMI score was 79.9 ± 9.1, FAOS 86.4 ± 15.2, and FFI 18.5% ± 9.3%. Wound healing complications were more frequent with dorsal plating than screw fixation. One nonunion required revision.
Conclusion:
MTP1 arthrodesis provides excellent long-term satisfaction and functional outcomes with low revision rates. Although radiographic adjacent-joint degeneration, particularly involving the interphalangeal joint, may occur over time, these changes do not appear to influence clinical outcomes.
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NewsBot · Jul 1, 2026

Long-term Outcomes After First Metatarsophalangeal Joint Arthrodesis: With Focus on Degenerative Changes on Adjacent Joints
Simon Recheis et al
Source

Background:
First metatarsophalangeal joint arthrodesis is a reliable treatment for painful end-stage degenerative, inflammatory, and post-traumatic conditions and severe deformities of the first ray. Although long-term functional outcomes are well documented, the incidence and relevance of degenerative changes in adjacent joints of the medial column after first metatarsophalangeal joint (MTP1) fusion remain uncertain.
Methods:
This exploratory single-center follow-up study included patients who underwent isolated MTP1 arthrodesis between 2012 and 2018. Preoperative and final follow-up weight-bearing radiographs were assessed for osteoarthritis progression in the interphalangeal (IP), tarsometatarsal (TMT1), naviculocuneiform (NC), and talonavicular (TN) joints using the Kellgren-Lawrence classification. Radiographic alignment parameters (hallux valgus angle, intermetatarsal angle, hallux-ground angle, and dorsal extension angle) were recorded. Clinical outcome was evaluated using American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal score (AOFAS HMI) score, Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and a study-specific questionnaire. Paired statistical tests and Pearson correlation analyses were performed.
Results:
Seventy-seven patients (45 female, 32 male) were available for follow-up at a mean of 106.9 ± 25.3 months. Radiographic osteoarthritis progression was significant in all assessed adjacent joints (P < .001) and was most pronounced in the IP joint (66 of 77 joints; 34 of 77 joints progressed by ≥2 grades). TMT1 progression occurred in 23 of 77 joints (≥2 grades in 5 of 77 joints), and NC or TN progression in 30 of 77 joints (≥2 grades: NC 6 of 77, TN 8 of 77). Radiographic alignment was not associated with adjacent-joint osteoarthritis progression, metatarsalgia, or patient-reported outcome. Overall, 90.9% reported good or excellent satisfaction. The mean AOFAS HMI score was 79.9 ± 9.1, FAOS 86.4 ± 15.2, and FFI 18.5% ± 9.3%. Wound healing complications were more frequent with dorsal plating than screw fixation. One nonunion required revision.
Conclusion:
MTP1 arthrodesis provides excellent long-term satisfaction and functional outcomes with low revision rates. Although radiographic adjacent-joint degeneration, particularly involving the interphalangeal joint, may occur over time, these changes do not appear to influence clinical outcomes.
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NewsBot · Jul 2, 2026

Distal Oblique Osteotomy vs Arthrodesis for Advanced Hallux Rigidus: A Matched Cohort Study
Jia Ying Lee et al
Foot Ankle Int. 2026 Jun 29:10711007261456291.

Background: Arthrodesis is regarded as the gold standard for advanced hallux rigidus, providing reliable pain relief but at the cost of first metatarsophalangeal (MTP) joint motion and implant-related complications. Distal oblique osteotomy (DOO) is a joint-preserving alternative that addresses dorsal impingement and altered biomechanics, but direct comparisons with arthrodesis in advanced disease remain limited.

Methods: This study retrospectively reviewed prospectively collected registry data from a single tertiary orthopaedic centre. Patients with advanced hallux rigidus who underwent first MTP joint arthrodesis or DOO after failing conservative management were included. Cohorts were matched for age, sex, body mass index, radiographic severity, and hallux valgus angle; however, residual differences remained between cohorts. Clinical outcomes assessed at a minimum of 24 months included patient satisfaction, complications, revision surgery rates, visual analogue scale (VAS) pain, American Orthopaedic Foot & Ankle Society (AOFAS), and range of motion (ROM) scores.

Results: Fifty-nine patients were included (arthrodesis = 28; DOO = 31). Both groups showed improvements in pain and function postoperatively. Patient satisfaction rates (arthrodesis = 25 [89.3%] vs DOO = 28 [90.3%], P > .05) and satisfaction score (arthrodesis = 2.14 [1.04] vs DOO = 1.84 [1.07], P > .05) were similarly high. The overall complication rate was lower (P = .025) in the DOO group (3.2%) compared with the arthrodesis group (28.6%), although complication profiles differed between procedures. Revision surgery rates were lower following DOO, although this difference was not statistically significant. AOFAS scores were higher in the DOO group, whereas the ROM was expectedly greater following DOO (P < .05), whereas postoperative VAS pain scores were comparable between groups.

Conclusion: DOO may represent a motion-preserving surgical option for selected patients with advanced hallux rigidus. In this study, DOO was associated with comparable patient satisfaction and pain relief to arthrodesis, with preservation of joint motion and lower observed complication rates. These findings suggest that DOO may be considered as an alternative in appropriate patients, although further prospective studies are required.
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NewsBot · Jul 5, 2026

Revision arthrodesis after first metatarsophalangeal joint arthroplasty: A nationwide analysis of implant type and revision-related factors
Arslan Kağan Arslan et al
Foot Ankle Surg. 2026 Jul 3:S1268-7731(26)00187-6.

Background: First metatarsophalangeal (MTP) joint arthroplasty is used as a motion-preserving option for hallux rigidus, but revision risk remains a concern.

Methods: We retrospectively analyzed patients who underwent first MTP joint arthroplasty in the Turkish national electronic health database between January 2018 and December 2023. Revision arthrodesis was assessed through November 20, 2025. Demographics, implant type, bilaterality, and comorbidities were compared between revised and non-revised patients.

Results: Among 901 patients, 192 underwent revision arthrodesis, yielding an observed cumulative revision rate of 21.3%. Revisions occurred frequently within 24 months. Total arthroplasty had a higher revision rate than hemiarthroplasty (23.4% vs 15.5%) and remained independently associated with revision after adjustment. Increasing age was associated with lower revision likelihood, whereas comorbidities were not independent predictors.

Conclusion: First MTP arthroplasty showed a substantial revision burden, particularly after total arthroplasty.
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NewsBot · Jul 8, 2026 at 1:57 AM

A Novel Treatment of Severe Hallux Rigidus with Hyaluronic
Acid Scaffold Interpositional Arthroplasty with Platelet-rich
Plasma Injection Cheilectomy First Metatarsophalangeal Joint:
A Surgical Technique
Nathania Mercado Pineda1 , Carlo Angelo Virrey Borbon2
Source

Hallux rigidus predisposes a person to insidious moderate to severe pain on ambulation and chronic disability. Current treatment options
include conservative management with injections, anti-inflammatory medications, physical therapy, orthotics, and shoe wear modifications. For
patients unresponsive to conservative measures, operative treatment with cheilectomy is considered the ideal treatment for moderate stages,
and arthrodesis is the gold standard treatment for advanced hallux rigidus. Interpositional arthroplasty and osteotomies are alternative options
for joint-preserving procedures. Emerging treatments in first-world countries include 1st metatarsophalangeal arthroplasty.
This paper describes a case of severe hallux rigidus with poor response to conservative management. Due to the patient’s desire to return to
predisease level of active lifestyle and the limited availability of surgical implants in the country, cheilectomy combined with the technique
of hyaluronic acid nonwoven scaffold interposition with platelet-rich plasma infusion of the first MTP joint was performed. Improvement in
functional and pain scales was noted at 1 year postoperative, and the patient was back to his premorbid state at 2 years postoperative. No
recurrence of pain and no limitation on ROM were noted on the most recent follow-up.
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NewsBot · Jul 9, 2026 at 1:25 AM

Revision arthrodesis after first metatarsophalangeal joint arthroplasty: A nationwide analysis of implant type and revision-related factors
Arslan Kağan Arslan et al
Source

Background
First metatarsophalangeal (MTP) joint arthroplasty is used as a motion-preserving option for hallux rigidus, but revision risk remains a concern.
Methods
We retrospectively analyzed patients who underwent first MTP joint arthroplasty in the Turkish national electronic health database between January 2018 and December 2023. Revision arthrodesis was assessed through November 20, 2025. Demographics, implant type, bilaterality, and comorbidities were compared between revised and non-revised patients.
Results
Among 901 patients, 192 underwent revision arthrodesis, yielding an observed cumulative revision rate of 21.3%. Revisions occurred frequently within 24 months. Total arthroplasty had a higher revision rate than hemiarthroplasty (23.4% vs 15.5%) and remained independently associated with revision after adjustment. Increasing age was associated with lower revision likelihood, whereas comorbidities were not independent predictors.
Conclusion
First MTP arthroplasty showed a substantial revision burden, particularly after total arthroplasty.
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NewsBot · Jul 10, 2026 at 12:31 AM

Outcomes following 1st metatarsophalangeal joint fusion for failed total joint arthroplasty
Source

Highlights

•
There are increasing numbers of 1st MTPJ replacements being performed for the treatment of end stage hallux rigidus.
•
Some 1st MTPJ replacements have a high failure rate.
•
Salvage arthrodesis for failed 1st MTPJ replacement improves functional outcomes.
•
The use of tricortical iliac crest bone graft reduces the non-union rate.

Abstract
Background
Increasing cases of 1st metatarsophalangeal joint (MTPJ) arthroplasty are being offered as an alternative to primary arthrodesis. Few studies analyze outcomes after salvage arthrodesis for failed 1stMTPJ arthroplasty. This study aims to determine the outcomes following conversion arthrodesis for failed total 1st MTPJ replacement.
Methods
A retrospective study of patients following 1stMTP joint arthrodesis for failed total joint arthroplasty from 2011 to 2024 was performed. Primary aim: to assess the union rate, secondary aims: to assess functional outcomes and surgical complications. Union was assessed radiographically. Functional outcomes: determined using the index Manchester-Oxford-Foot Questionnaire (MOxFQ) scores (0−100) postoperatively. Intraoperative and post-operative surgical complications were evaluated.
Results
18 1stMTPJs in 14 patients had arthrodesis for failed total joint replacements. 4 had bilateral arthrodesis at different sittings. Mean age at revision arthrodesis was 57.9 years (48–79years). 13 explanted joints were Toefit-Plus™,5 were Roto-Glide™. Mean time from primary arthroplasty to arthrodesis was 59.9months (11–112months). 17 joints had tricortical iliac crest grafting, one had a sliding metatarsal graft. Mean time to radiographic union was 16.6 weeks (SD 6.0; 95% CI 13.7–19.4; range 8–28weeks). Median postoperative MOxFQ score was 5.5 (IQR 3.5–12.5; range 0–34.4). 1 patient (5.6%) had symptomatic nonunion, 2 (11.1%) had malunion and 2 (11.1%) had symptomatic hardware. One patient had lateral femoral cutaneous nerve injury from anterior iliac crest bone graft harvest.
Conclusion
1stMTPJ arthrodesis after failed total joint replacement is a complex procedure due to bone loss. The use of structural iliac crest bone graft reduces the nonunion rates to be closer to those of literature reports for primary arthrodesis. There are favorable functional outcomes following this procedure with relatively high surgical complications and longer time to radiographic union compared to that of primary arthrodesis. Further highly powered comparative studies may better guide the management of failed total 1stMTPj arthroplasty.
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NewsBot · Jul 11, 2026 at 12:49 AM

The Effect of Traditional Open Cheilectomy vs Percutaneous Minimally Invasive Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-analysis
Nadav Moses et al
Foot & Ankle Surgery: Techniques, Reports & Cases
Volume 6, Issue 3, Autumn 2026, 100658

Background
Hallux rigidus is a degenerative disorder of the first metatarsophalangeal (MTP) joint characterized by pain and restricted dorsiflexion. Cheilectomy is a joint preserving option for early to moderate disease, traditionally performed through an open approach. Percutaneous minimally invasive surgery (MIS) has emerged as an alternative that may reduce soft-tissue disruption. This systematic review and meta-analysis compared outcomes of open versus MIS cheilectomy.
Methods
A PRISMA-compliant systematic review (PROSPERO CRD420251108211) was conducted using PubMed, Embase, Google Scholar, and Cochrane databases (April–August 2025). Studies reporting outcomes of open or MIS cheilectomy in adults with mild–moderate hallux rigidus were included. Primary outcomes were pain (VAS) and complications/reoperations. Quality was assessed with MINORS. Random-effects meta-analyses were performed, with indirect comparisons between techniques due to lack of head-to-head studies.
Results
Seventeen studies (907 patients, 968 feet) were included: 431 MIS and 537 open. Both approaches improved pain and ROM. VAS reduction was similar (MIS −52.6 vs open −53.3; p = 0.91). Total ROM improved comparably (MIS +23.4°, open +21.7°; p = 0.89), with high heterogeneity. Reoperation rates were higher in MIS (9.8% vs 5.6%; p = 0.003). Complication reporting was inconsistent.
Conclusion
Both techniques provide clinical improvement. MIS show higher reoperation rates and substantial heterogeneity. Evidence is low quality and indirect; no clear superiority can be established.
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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

Sensory Nerves at Risk During Hallux Valgus Surgery

Central Sensitization and Outcomes After Hallux Valgus Surgery

Hallux Valgus Surgery is Failing Long Term

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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

Sensory Nerves at Risk During Hallux Valgus Surgery

Central Sensitization and Outcomes After Hallux Valgus Surgery

Hallux Valgus Surgery is Failing Long Term

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