There have been few long-term studies documenting the outcome of surgical
treatment of hallux rigidus. The purposes of this report were to evaluate the
long-term results of the operative treatment of hallux rigidus over a
nineteen-year period in one surgeon's practice and to assess a clinical
grading system for use in the treatment of hallux rigidus.
All patients in whom degenerative hallux rigidus had been treated with
cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and
who were alive at the time of this review were identified and invited to
return for a follow-up evaluation. At this follow-up evaluation, the hallux
rigidus was graded with a new five-grade clinical and radiographic system.
Outcomes were assessed by comparison of preoperative and postoperative pain
and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of
motion. These outcomes were then correlated with the preoperative grade and
the radiographic appearance at the time of follow-up.
One hundred and ten of 114 patients with a diagnosis of hallux rigidus
returned for the final evaluation. Eighty patients (ninety-three feet) had
undergone a cheilectomy, and thirty patients (thirty-four feet) had had an
arthrodesis. The mean duration of follow-up was 9.6 years after the
cheilectomies and 6.7 years after the arthrodeses. There was significant
improvement in dorsiflexion and total motion following the cheilectomies (p =
0.0001) and significant improvement in postoperative pain and AOFAS scores in
both treatment groups (p = 0.0001).
A good or excellent outcome based on patient self-assessment, the pain
score, and the AOFAS score did not correlate with the radiographic appearance
of the joint at the time of final follow-up. Dorsiflexion stress radiographs
demonstrated correction of the elevation of the first ray to nearly zero.
There was no association between hallux rigidus and hypermobility of the first
ray, functional hallux limitus, or metatarsus primus elevatus.
Ninety-seven percent (107) of the 110 patients had a good or excellent
subjective result, and 92% (eighty-six) of the ninety-three cheilectomy
procedures were successful in terms of pain relief and function. Cheilectomy
was used with predictable success to treat Grade-1 and 2 and selected Grade-3
cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with
<50% of the metatarsal head cartilage remaining at the time of surgery
should be treated with arthrodesis.