Surgery for hallux rigidus

NewsBot · May 29, 2025

Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis
Ryan Sanii et al
Foot Ankle Orthop. 2025 Mar 29;10(1):24730114251324184.

Background: A modern technique for the treatment of hallux rigidus (HR) is first metatarsophalangeal (MTP) hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. Current scientific literature reporting early outcomes of the procedure is sparse and mixed, indicating the need for further analysis. The objective of this study was to compare improvement in visual analog scale (VAS) scores with first MTP hemiarthroplasty with Cartiva implant (HI), allograft interposition arthroplasty (IA), and arthrodesis (A) in patients who failed conservative management or cheilectomy.

Methods: A retrospective cohort study of 99 patients was performed. There were 49 patients in the HI group, 25 patients in the IA group, and 25 patients in the A group. A follow-up survey was administered from which updated VAS and updated American Orthopaedic Foot & Ankle Society scores were obtained.

Results: Mean VAS scores improved by 2.73 (SD ± 2.80) points in the HI group, 4.16 (SD ± 2.01) points in the IA group, and 4.36 (SD ± 3.67) points in the A group (P = .035). Mean AOFAS scores improved by 14.90 (SD ± 17.31) points in the HI group, 27.80 (SD ± 15.22) points in the IA group, and 27.88 (SD ± 25.34) points in the A group (P = .005). There were 3 (6.1%) revision surgeries in the HI group, 2 (8.0%) revision surgeries in the A group, and no revision surgeries in the IA group (P = .59). Within the HI group, all 3 revisions were due to pain associated with the implant and were revised to MTP arthrodesis. The A group had 1 revision due to broken hardware and 1 revision due to infection. In both cases, the patients were treated with hardware removal.

Conclusion: Pain and function may be slightly more improved with interpositional arthroplasty and arthrodesis for the treatment of HR, when compared to hemiarthroplasty with the Cartiva implant.
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NewsBot · Jun 5, 2025

Minimally Invasive vs Open First Metatarsophalangeal Joint Cheilectomy: Radiographic Outcomes and Early Complications
Noopur Ranganathan
Arch Bone Jt Surg. 2025;13(3):152-156.

Objectives: Current literature on surgical techniques has evaluated minimally invasive surgery (MIS) cheilectomy and its efficacy in comparison to the open technique. However, no study to date has evaluated MIS-Moberg in relation to open and MIS cheilectomy. This study assessed radiological outcomes and early healing and complications of patients who underwent open, MIS, and MIS-Moberg cheilectomies.

Methods: We conducted a retrospective cohort review of 134 patients who underwent first metatarsophalangeal (MTP) cheilectomy at an academic medical center between 2015 and 2024. Success of cheilectomy was determined radiographically. Postoperative complications were identified through medical record review.

Results: 73 open and 61 MIS cheilectomies were performed on 134 patients with a primary diagnosis of hallux rigidus. The pre-operative versus post-operative differences in dorsal cortical length (3.7±1.4) and sagittal articular P1 angle (7.3±4.8) were found to be statistically significant (P<0.05) for the MIS-Moberg group. Ten patients in the open cheilectomy were found to have dorsiflexion and plantarflexion stiffness compared to zero patients in the MIS and MIS-Moberg groups (P<0.01).

Conclusion: We showed a significantly greater rate of plantar- and dorsiflexion stiffness in open surgeries compared to MIS and MIS-Moberg. No other differences in healing rates or radiologic outcomes were observed. Based on preliminary results, the MIS-Moberg can successfully alter the radiographic alignment of the great toe and does not increase complications as compared to open or MIS cheilectomy alone.
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NewsBot · Jun 5, 2025

Defining the patient acceptable symptom state (PASS) for PROMIS after Hallux Rigidus correction surgery
Allison L. Boden et al
Source

It is unclear which patient reported outcome metric correlates best with clinical improvement. The patient acceptable symptom state (PASS) incorporates the patient's subjective outcome experience into the outcome measurement. This study aims to establish PASS thresholds using Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients undergoing hallux rigidus (HR) correction. A retrospective review of prospectively collected data identified 144 patients who were treated surgically for HR between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS scores, and had responses to two distinct PASS anchor questions. PASS thresholds were determined using the maximum Youden Index. Differences in demographic and surgical characteristics between patients who met or did not meet the PASS thresholds were compared using independent samples T-tests and Pearson Chi-Square tests. Overall, 70 % of patients met the PASS thresholds. Patients with better baseline PROMIS scores were more likely to meet the postoperative PASS thresholds for every PROMIS domain (p < 0.05). Patients who did not undergo first metatarsophalangeal (MTP) fusion were more likely to reach the PASS threshold for the Physical Function domain (p = 0.045). For the Pain Intensity domain, younger patients were more likely to meet the thresholds (p = 0.005). Patient sex, BMI, and use of either cheilectomy or Akin/Moberg osteotomy during surgery did not impact a patient's likelihood of meeting the PASS thresholds. After surgical intervention for HR, it may not be necessary for patients to reach normal physical function or pain levels in order to reach an acceptable postoperative symptom state.
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NewsBot · Jun 11, 2025

Rate of Subsequent Hallux Interphalangeal Joint Fusion After First Metatarsophalangeal Fusion: A National Database Study with Verified Continued Patient Enrollment
Eslam Alkaramany et al
Foot Ankle Int. 2025 Jun;46(6):629-632.

Background: The risk of symptomatic degeneration at the interphalangeal (IP) joint after arthrodesis of the hallux metatarsophalangeal (MTP) joint remains undetermined and is a common question from patients considering the procedure. This study investigated the rate of subsequent hallux IP joint fusion after first MTP joint arthrodesis.

Methods: Patients who underwent hallux MTP joint arthrodesis were identified from a large national commercial insurance database (PearlDiver) by Current Procedural Terminology (CPT) code. Patients who underwent first IP fusion were also identified. To ensure continued enrollment of patients, the subset of patients with verified insurance claims in the database for all of the subsequent 10 years were analyzed. The Kaplan-Meier curve for survivorship free of subsequent IP fusion was generated covering 10 years from the index operation.

Results: Of 15,771 patients with MPT joint arthrodesis active on the database to 10 years, 166 had IPJ fusion after MPT joint fusion. The risk of undergoing IP fusion within 10 years after a previous first MTP fusion was 1.052% (95% CI 0.9%-1.1%). The mean time between the 2 procedures was 4.0 years. Because CPT codes in the database were reported without laterality, a small subset of patients may have undergone subsequent contralateral IP fusion. Therefore, this result should be regarded as an upper limit of the estimated rate.

Conclusion: The rate of subsequent hallux IP joint fusion of around 1% within 10 years after a first MTP joint fusion in this large database population highlights the durability of the clinical result of first MTP joint fusion and should reassure patients and surgeons considering the procedure.
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NewsBot · Jun 14, 2025

Short-Term Outcomes of First Metatarsophalangeal Arthroplasty Using the Silktoe Double-Stemmed Silicone Implant
Stefano Fieschi et al
Diagnostics (Basel). 2025 May 27;15(11):1349.

Background: Hallux rigidus is a painful and degenerative pathology of the first metatarsophalangeal (MTP1) joint. In severe cases it is usually appropriate to consider arthrodesis or arthroplasty of the joint. Arthrodesis represents the gold standard, but arthroplasty allows patients to recover mobility. Although arthroplasty has slightly inferior functional results to arthrodesis, it has shown very good results in terms of joint mobility, patient satisfaction and pain reduction. The goal of the present study was to evaluate short-term outcomes of patients that received a third-generation double-stemmed MTP1 implant manufactured from high-performance silicon. Methods: In this retrospective study the authors analyzed data of 37 patients who underwent MPT1 joint arthroplasty with SilktoeTM double-stemmed implant using the R 4.2.2 software (R Foundation for Statistical Computing, Vienna, Austria). The indications were hallux rigidus of grade III and grade IV (81.1%), hallux rigidus plus valgus (10.8%), painful or unstable joint following previous surgery (5.4%) and hallux rigidus due to gout (2.7%). Data were collected during routine visits at 1 and 6 months and 1 and 2 years. Results: There were no intraoperative and postoperative complications. There were no revisions or reoperations at a follow-up of two years. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS-HMI) score was 94.6 ± 7.6 (median, 100; range, 70-100) and the Visual Analogue Scale (VAS) score was 0.4 ± 0.80 (median, 0; range, 0-3.5) at the final follow-up. Conclusions: The data from this study presented excellent short-term results for patients who received an arthroplasty of the MTP1 joint using a third-generation double-stemmed spacer made of high-performance silicone. For all patients who received the SilktoeTM implant, AOFAS-HMI scores of 94.6 and VAS scores of 0.4 were obtained at a two-year follow-up. These values were in line with results reported in the literature for similar devices.
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NewsBot · Jun 19, 2025

Medial Sesamoidectomy as a Local Autograft Source in Revision or Complex First Metatarsophalangeal Joint Arthrodesis
Aaron Tran et al
Foot Ankle Orthop. 2025 Jun 16;10(2):24730114251343071.

Background: Arthrodesis of the first metatarsophalangeal (MTP) joint is a well-established procedure with excellent outcomes for patients with forefoot disorders. Routine bone grafting is not typically required, but bone graft may be necessary in the setting of revision surgery. Because of potential harvesting morbidity and time associated with an extra incision, allograft bone is frequently used. In this study, we describe the outcomes of an approach to first MTP fusion with simultaneous medial sesamoidectomy for utilization as autograft.

Methods: A retrospective review of all first MTP arthrodesis cases performed by one fellowship-trained foot and ankle surgeon were identified. Operative reports and radiographs were reviewed identifying patients who underwent simultaneous medial sesamoidectomy for autograft purposes. Indications for sesamoidectomy harvesting were noted. The primary outcome reviewed was fusion rate. Overall nonunion rates and patient outcomes were collected and compared between those undergoing sesamoidectomy for grafting and those undergoing standard procedure arthrodesis.

Results: A total of 107 patients underwent first MTP arthrodesis. Of these, 24 underwent concurrent sesamoidectomy grafting with 9 requiring additional calcaneal grafting. Indications for the sesamoidectomy group included 5 primary cases of erosive hallux rigidus, 2 cases of hallux valgus, 6 nonunions, 3 failed Cartiva implants, 2 cases of avascular necrosis, 4 failed arthroplasties, and 2 conversion bunionectomy. All 24 patients in the sesamoidectomy group achieved successful union. For context, the broader cohort undergoing first MTP arthrodesis had a fusion rate of 92.1%. All patients in the sesamoidectomy group were satisfied with their surgical outcome.

Conclusion: This study found highly successful fusion rates in a potentially higher risk population with the use of local autografting from the medial sesamoid. The medial sesamoid serves as a freely available, structurally supportive graft material for first MTP arthrodesis that can be readily harvested via the same incision, potentially reducing the need for additional graft sites. However, given the retrospective nature, single-surgeon cohort, and small sample size, further studies are warranted to confirm these findings and evaluate comparative outcomes.
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NewsBot · Jun 28, 2025

Great Toe Joint Hemi-Implant Failure
A Case of Cobalt Metal Allergy
James J. DiResta and Angela Barnes

Hemi-joint implants for treatment of osteoarthritis of the great toe joint have been known to fail at times from a variety of reasons and often requires a return to the operating room for removal and/or conversion. We present an interesting case of a cobalt hemi-implant failure from metal allergy 16 months after implantation. This is an underreported event in podiatric literature. We present an interesting discussion, as we feel a review of metal allergy occurrence with joint implant replacement, whether preoperative screening, patch testing, or lymphocyte transformation testing might be of value. We encourage foot and ankle surgeons to include implant allergy in their differential diagnosis as a possible cause of implant failure.
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NewsBot · Jun 29, 2025

Biomechanical Comparison Between Fixation Techniques for First-Metatarsophalangeal Joint Arthrodesis
Chase M. Romere et al
Source

Background:
Metatarsophalangeal (MTP) arthrodesis is the gold standard for treatment of end-stage degeneration or severe hallux valgus deformities. Traditional fixation uses stainless steel or titanium plates, often with a crossing screw. Nitinol, a superelastic nickel-titanium alloy, offers dynamic compression. Nevertheless, it is unknown how nitinol implantation in the context of first-MTP arthrodesis performs biomechanically. We hypothesized that nitinol constructs would demonstrate biomechanical performance comparable or superior to a traditional plate-and-screw construct.
Methods:
Twelve pairs of cadaveric metatarsophalangeal joints were organized into 3 groups according to a balanced incomplete block design: (1) a traditional titanium plate and cross-screw (PS) construct, (2) a nitinol staple and cross screw (NSS) construct, and (3) a proprietary nitinol hybrid screw (NHS) construct. The PS construct consisted of a plate with a compression cross screw; the NSS construct consisted of a nitinol staple with a compression cross screw; and the NHS construct consisted of a hybrid nitinol staple with a compression cross screw. Each specimen was cyclically loaded over 100 cycles at 1 Hz from 20 to 90 N followed by failure testing. A high-definition camera recorded gapping. Failure load, deflection, and stiffness were recorded.
Results:
Compared with the PS construct, both nitinol constructs (NSS and NHS) demonstrated significantly higher failure loads (NSS: 196 ± 101 N, P = .011; NHS: 161 ± 45 N, P = .045), greater stiffness (NSS: 33 ± 15 N/mm, P = .012; NHS: 29 ± 12 N/mm, P = .042), reduced deflection after cyclic loading (NSS: 6 ± 3 mm, P = .047; NHS: 7 ± 3 mm, P = .048), and decreased gapping at failure (NSS: 1 ± 1 mm, P = .003; NHS: 2 ± 1 mm, P = .008). No significant differences were observed between NSS and NHS.
Conclusion:
Nitinol constructs for MTP arthrodesis demonstrated superior mechanical performance compared with a traditional plate-and-screw construct, with higher failure load and stiffness.
Clinical Relevance:
These results support the growing use of nitinol for joint fusion, highlighting its potential to improve load to failure and reduce displacement under cyclic loading.
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NewsBot · Jul 15, 2025 at 2:37 AM

Hallux Rigidus with an Increased or Equal First Metatarsal Length after a Cheilectomy and First Metatarsal Shortening Osteotomy (FMSO) Using a Small Shortening Scarf: A Retrospective 7-year Clinical and Gait Analysis Follow-up
Karl-Heinz Kristen et al
Source

Background
In hallux rigidus, the relative length of the first metatarsal has been implicated in its pathogenesis, suggesting a potential benefit from combined surgical approaches.
Purpose
To evaluate the long-term outcomes of a combined surgical approach using cheilectomy and shortening SCARF osteotomy for moderate hallux rigidus (Coughlin grades 2-3) in active patients with a first metatarsal index equal to or longer than the second metatarsal.
Study Design
Retrospective cohort study.
Methods
Twenty-three feet in 20 patients (mean age 49.4 ± 8.4 years) underwent combined cheilectomy and 4-mm shortening SCARF osteotomy. Outcomes were assessed at a mean follow-up of 6.7 ± 2.5 years using the American Orthopedic Foot and Ankle Society and European Foot and Ankle Surgery scores, range of motion, and gait analysis.
Results
American Orthopedic Foot and Ankle Society scores improved from 32.2±11.7 preoperatively to 86.6±6.2 at the follow-up, and European Foot and Ankle Surgery scores increased from 13.8±2.8 perioperatively to 35.4±3.9 at the follow-up. The total range of motion increased from 32.8° to 44.7° ±16,3°. Gait analysis revealed a physiological plantar pressure distribution at follow-up. Complications included the recurrence of joint stiffness and pain in three patients and transient transfer metatarsalgia in one patient.
Conclusion
Shortening SCARF osteotomy plus mild cheilectomy may be an effective joint-preserving procedure in patients with first metatarsal overlength, with results comparable to those of cheilectomy and other first metatarsal shortening osteotomies.
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NewsBot · Jul 16, 2025 at 5:58 AM

Outcomes Following Minimally Invasive vs Open Cheilectomy for Hallux Rigidus: A Systematic Review
Caroline Cristofaro et al
Foot Ankle Spec. 2025 Jul 2:19386400251345538.

IntroductionHallux rigidus is common and can be disabling for patients. Once conservative management is exhausted, surgical treatment is considered. For earlier stage hallux rigidus, cheilectomy can be offered to patients. Traditionally, open cheilectomy has been performed, but minimally invasive cheilectomy is becoming increasingly popular. The purpose of this systematic review is to compare the outcomes of minimally invasive vs open cheilectomy for hallux rigidus.MethodsTwo comprehensive literature searches of Ovid MEDLINE and EMBASE were performed for relevant publications from January 1, 1995 to April 9, 2024. Search terms focused on open and minimally invasive surgery (MIS) cheilectomy were used. All full-text, English-language, clinical studies reporting on MIS and open cheilectomy outcomes and/or complications were included. Article screening, critical appraisal, and data extraction were performed independently by 2 reviewers.ResultsNine MIS cheilectomy studies were identified, reporting on a total of 442 patients (95 males, 214 females, and 133 not reported) with 464 feet operated on. The weighted mean age and follow-up were 50.7 ± 4.6 years and 33. 5 ±14.0 months, respectively. Fifteen open cheilectomy studies were identified, yielding 720 patients (199 males, 319 females, and 202 not specified) and 763 operated feet. The weighted mean age and follow-up was 53.2 ± 4.7 years and 64.5 ± 28.3 months, respectively. Functional outcomes are similar following open or MIS cheilectomy. The MIS cheilectomy studies reported a total of 37 complications (8.2%) and 43 revision surgeries (9.3%). Complications and revision surgery following open cheilectomy were 14.7% (n = 112) and 5.0% (n = 38), respectively. Complications following open cheilectomy were higher than with MIS cheilectomy (P = .001). However, revision surgery was found to be higher in patients following MIS cheilectomy (P = .003).ConclusionSurgical complications following MIS cheilectomy were found to be less common when compared to open cheilectomy. However, there may be an increased risk of revision surgery following MIS cheilectomy
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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

Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following 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

Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

Share This Page

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