Distal Oblique First Metatarsal Osteotomy in Grade 3 Hallux Rigidus: A Long-Term Followup

Background: While some studies have demonstrated that metatarsus primus elevatus in hallux rigidus is an uncommon secondary change rather than a causative factor, we believe it is, in fact, more common. We advocate surgical treatment if the first ray is elevated beyond normal range, thereby acting as a decompression realignment osteotomy. Materials and Methods: We analyzed patients operated between June 1994 and December 1996. Oblique distal osteotomy of the first metatarsal was performed in 20 patients. A retrospective review of clinical and radiological outcomes was performed including an AOFAS score and patient satisfaction scale. The postoperative ROM was evaluated with lateral radiographs in maximum plantar/dorsiflexion. The average followup was 11.1 (range, 8.7 to 13.6) years. Results: One case of metatarsalgia was the only postoperative complication. The average AOFAS score increased from 44 (range, 14 to 68) to 82 (range, 80 to 100). Good to excellent results were achieved in 19 patients. The mean passive dorsiflexion of the first MTP joint improved from 8 degrees (range, 5 degrees to 10 degrees) to 44 degrees (range, 15 degrees to 55 degrees). No patient underwent subsequent surgery. Conclusion: The oblique osteotomy is a safe and reliable procedure for treatment of painful hallux rigidus. In our experience, it yields good and excellent results with high patient satisfaction and low complication rates.