Minimally invasive cheilectomy for the treatment of grade I-III hallux rigidus: a prospective study reporting on early patient outcome

P. Pastides, C. Charalambides

Introduction: Hallux rigidus is a benign condition that tends to be slow to progress that commonly affects adults of working age, leading to significant restriction of everyday function and recreational activities. We report a prospective case series of 41 patients treated for grade I to III hallux rigidus with minimally invasive cheilectomy. Patients were evaluated and outcomes quantified using the AOFAS-HMI scoring system.

Methods: 54 feet formed our patient cohort. The mean age was 43 (range, 16-61). A 1cm incision is made proximally and over the dorsomedial aspect of joint capsule. The tissues are cleared off the bone and a 3.1mm conical burr is used to shave the dorsal osteophytes. All patients were discharged on the same day.

Results: Mean follow up AOFAS-HMI scores at 17 months (range 6-30 months) was 87.1. Most patients (88%) return to the clinic in their own shoes at two weeks (36 out of 41) and all of them at six weeks. Thirty patients (73%) had returned to some sporting activities by six weeks post the procedure, 24 (59%) to non impact (swimming, cycling, cross trainer) and six patients (14%) had return to impact activities (tennis, squash). The rest of the patients did not participate in any sports or reported postoperative problems. There were no intra operative or post operative wound complications. All patients were discharged home on the day of operation. Isolated cases of painful scars and altered sensation on the dorsum of the great toe completely resolved by three to six months.

Conclusion: Minimally invasive cheilectomy is a new, attractive and currently successful method of treating grade I to III hallux rigidus. The minimally invasive approach has the benefit of less soft tissue disruption which causes minimal pain and hence a fast return to daily activities and work.