Outcomes after Cheilectomy with Phalangeal Dorsiflexory Osteotomy for Hallux Rigidus: A Systematic Review

Abstract 

Cheilectomy with phalangeal dorsiflexory osteotomy has been proposed for treatment of hallux rigidus because of its perceived safety and efficacy and because it does not prevent the ability to perform revision surgery. The author undertook a systematic review to identify material relating to the clinical outcomes after cheilectomy with phalangeal dorsiflexory osteotomy for hallux rigidus. Studies were considered only if they involved consecutively enrolled patients undergoing cheilectomy with phalangeal dorsiflexory osteotomy, evaluated patients at mean follow-up ≥ 12 months' duration, included some form of objective and subjective data analysis, and included details of complications requiring surgical intervention. Eleven studies involving a total of 374 procedures were identified that met the inclusion criteria. Pain was relieved or improved in 149/167 (89.2%) procedures, and 139/217 (77%) patients related being satisfied or very satisfied with their outcomes. A total of 18 (4.8%) procedures underwent surgical revision. Six studies involving 177 procedures specified the grade of hallux rigidus as follows: grade I, 10.2% (n = 18); grade II, 72.3% (n = 128); and grade III, 17.5% (n = 31). The results of this systematic review make clear the general improvement in objective and subjective data as well as the low incidence of revision surgery required after cheilectomy with phalangeal dorsiflexory osteotomy for hallux rigidus. Therefore, cheilectomy with phalangeal dorsiflexory osteotomy should be considered a first-line surgical treatment for hallux rigidus. However, there is still a need for methodologically sound prospective cohort studies that focus on the use of this procedure for specific grades of hallux rigidus and compare the subjective and objective outcomes as well as the need for surgical revision with other procedures.

Level of Evidence: 2

Keywords: degenerative joint disease, hallux limitus, first metatarsal-phalangeal joint, osteoarthritis, surgery