Joint preserving miniinvasive surgery for hallux rigidus: patient group evaluation, first experience
Abstract
Introduction: Surgical management of hallux rigidus has gained an option for improvement by rising percutaneous techniques. According to this trend, we started to use minimally invasive percutaneous techniques in foot and ankle.
We have just evaluated patient group who have undergone joint preserving surgery of first MTP joint for hallux rigidus. Material and method: There are 24 patients included in the study which has to follow subjective and objective patient data collected into 2 scoring systems: AOFAS Hallux metatarsophalangeal-interphalangeal score and VAS score.
These two scoring systems were completed with every patient 6 weeks, 3 months and 6 months from the surgery. A single cheilectomy was performed with or without a decompression Moberg osteotomy of proximal phalanx.
Indication for surgery depended on hallux rigidus deformity stage by Coughlin and Shurnas classification. Patients, who suffered 1st and 2nd stage without any artritic changes except for dorsal osteofyte on metatarsal head, were indicated for single cheilectomy.
Cases with more severe deformity classified into 2nd and 3rd stage with visible artritic changes on x-ray were indicated cheilectomy and additional Moberg osteotomy. Both procedures performed in percutaneous way under x-ray control.
Results: We found the best outcome in 6 month monitoring in patients who were treated by cheilectomy with adjacent Moberg osteotomy and belonged to grade 2 classification subgroup. One revision procedure had to be made in case of severe progression of MTP joint arthritis.
MTP joint fusion was performed. There was no early complication concerning wound healing and infection.
Discussion: The removal of isolated metatarsal head dorsal osteofyte in percutaneous way has confirmed good clinical results, which are postulated by recent literature. If there is further damage than isolated dorsal osteofyte a decompression osteotomy should be made.
In the end, there are several options how to decompress MTP joint line: proximal phalanx osteotomy, metatarsal osteotomy or even TMT joint fusion.