Prospective Assessment of Dorsal Cheilectomy for Hallux Rigidus Using a Patient-reported Outcome Score

Harrison, T; Fawzy, Ernest; Dinah, Feroz; Palmer, Sylvain

doi:10.1053/j.jfas.2010.02.004

Cited by 35 publications

(16 citation statements)

References 21 publications

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“…11 It has been validated for use in open dorsal cheilectomy for hallux rigidus. 7 The patients were also requested to complete a visual analog scale (VAS) pain score.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

et al. 2018

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Background: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). Methods: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. Results: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. Level of Evidence: Level IV, retrospective case series.

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“…11 It has been validated for use in open dorsal cheilectomy for hallux rigidus. 7 The patients were also requested to complete a visual analog scale (VAS) pain score.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

et al. 2018

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“…However, no study has compared these procedures directly, and both cheilectomy operations and combined cheilectomy with Moberg osteotomy procedures have been shown to have excellent results. 7,14…”

Section: Discussionmentioning

confidence: 99%

Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

Henry

Kraszewski

Volpert

et al. 2020

Foot & Ankle Orthopaedics

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Background: Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods: This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results: Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion: Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence: Level II, prospective comparative study.

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“…Symptoms will result from first MTPJ range of motion in a cartilage-denuded joint, usually in the dorsal one half to one third of the joint, with concomitant irritation of a dorsal prominence in footwear ( Fig. 1) (2). These symptoms will be aggravated by activities that require first metatarsophalangeal dorsiflexion, such as squatting, wearing high heel shoes, ascending an incline, running, and cross-country skiing (3).…”

mentioning

confidence: 99%

“…Conservative treatment options include shoe gear modifications (rocker-bottom shoes, stiff-soled shoes, metatarsal roll bar), nonsteroidal anti-inflammatory drugs, cortisone injections, analgesics, activity modification, orthotics modified with a Morton's extension, and carbon fiber inserts (4,11). Several surgical treatments have been proposed for hallux rigidus, including excision arthroplasty (Keller osteotomy), interpositional arthroplasty, decompression osteotomies, cheilectomy, and arthrodesis (2).…”

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confidence: 99%

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Long-Term Follow-Up of the Cheilectomy for Degenerative Joint Disease of the First Metatarsophalangeal Joint

Nicolosi

Hehemann

Connors

et al. 2015

The Journal of Foot and Ankle Surgery

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Prospective Assessment of Dorsal Cheilectomy for Hallux Rigidus Using a Patient-reported Outcome Score

Cited by 35 publications

References 21 publications

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

Long-Term Follow-Up of the Cheilectomy for Degenerative Joint Disease of the First Metatarsophalangeal Joint

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