Sliding Oblique Metatarsal Osteotomy Fixated With K-Wires Without Cheilectomy for All Grades of Hallux Rigidus: A Case Series of 76 Patients

Abstract

Background: Studies on decompression metatarsal osteotomy without cheilectomy for hallux rigidus are limited. This study aimed to review the data of patients who underwent this surgery for all grades of hallux rigidus. Methods: The medical records of patients who underwent this surgery between August 2017 and January 2021 were retrospectively reviewed. The outcomes were assessed using the visual analog scale (VAS), the Japanese Society for Surgery of the Foot (JSSF) score, and the hallux dorsiflexion angle. Patients who were followed up for more than 2 years were included. The plantar shift of the first metatarsal head (PS) and the shortening of the first metatarsal (SH) were measured to supplementally investigate the associations with other measurements. Results: A total of 76 patients (female, 42; male, 34; mean age, 60.3 years; mean body mass index, 23.1) with 80 feet were enrolled. Six patients (7.5%) were grade 1, 20 (25.0%) were grade 2, 30 (37.5%) were grade 3, and 24 (30.0%) were grade 4. The mean follow-up duration was 3.5 years. Overall, the mean VAS score improved from 63.2 to 6.2, the mean JSSF score from 59.0 to 82.6, and the mean dorsiflexion angle from 37.3 to 56.3 degrees. These measures improved for all grades, but the dorsiflexion angles and JSSF scores decreased as the grade advanced. No clear associations were found between the postoperative VAS and the PS and SH. Eight patients (10.5%) had complications: 4 (5.2%) had occasional plantar discomfort under the metatarsal head, 2 (2.6%) required shoe modification, 1 (1.3%) had wound pain, and 1 (1.3%) experienced breakage of a K-wire. Conclusion: The VAS scores, dorsiflexion angles, and JSSF scores improved for all grades of hallux rigidus within a relatively short period of follow-up; however, the dorsiflexion angles and JSSF scores decreased as the grade advanced. Level of Evidence: Level IV, retrospective case series.

Distal Metatarsal and Proximal Phalangeal Osteotomies without Soft Tissue Procedure for Hallux Valgus with 80° Hallux Valgus Angle: A Case Report

“…A 2-cm skin incision with a 60° inclination to the metatarsal axis was made over the medial aspect of the first metatarsal neck, and blunt dissection was performed to expose the metatarsal neck [ 3 , 4 ]. The periosteum was then incised and denuded [ 3 ].…”

“…A 2-cm skin incision with a 60° inclination to the metatarsal axis was made over the medial aspect of the first metatarsal neck, and blunt dissection was performed to expose the metatarsal neck [ 3 , 4 ]. The periosteum was then incised and denuded [ 3 ]. Wedge osteotomy was performed at the metatarsal neck; the distal cut was perpendicular to the metatarsal shaft, and the base of the wedge was 7-mm wide ( Fig.…”

“…A 2-cm skin incision with a 75° inclination to the proximal phalanx axis was made over the medial aspect of the proximal one-third of the proximal phalanx, and blunt dissection was performed to expose the bone [ 3 , 7 ]. The periosteum was incised and denuded, and wedge osteotomy was performed at one-third of the proximal phalanx, which was at the same level as the first web space; the base of the wedge was medial and 2-mm wide ( Fig.…”