Cheilectomy Combined With First Tarsometatarsal Joint Arthrodesis for Surgical Treatment of Midstage Hallux Rigidus Complicated by Medial Column Insufficiency: Prospective Evaluation of Outcomes

Published:February 10, 2020DOI:


      The role of metatarsus primus elevatus and first ray hypermobility is under scrutiny with regard to the pathoanatomy of hallux rigidus. Regardless of the underlying biomechanical cause, there is a subset of patients with hallux limitus present with concomitant insufficiency of the medial column identified on clinical exam and lateral imaging as dorsal divergence of the first compared with the second metatarsal. While cheilectomy and decompression metatarsal osteotomy are commonly used to mitigate retrograde forces at the first metatarsophalangeal joint (MPJ) level, traditional hallux limitus procedures do not address more proximal deformity of the medial column. Although the authors prefer to treat this complex condition with cheilectomy combined with tarsometatarsal joint arthrodesis, there is a paucity of literature on this approach. A prospective cohort study of consecutive patients was therefore performed to assess outcomes. Ten patients (3 males, 7 females) and 11 feet (8 right and 3 left) met the inclusion criteria. Mean follow-up was 21.9 months (range 12 to 52). Average age was 50.4 years (range 28 to 61). The average preoperative ACFAS score of 49.6 (range 29 to 61) improved to 78 (range 51 to 92) at 10 weeks postoperatively and 85.4 (range 60 to 100) at 1 year postoperatively. By 1 year postsurgery, 9 of 10 patients (90%) described their satisfaction level as very satisfied, and 1 (10%) was somewhat satisfied.

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        • Horton G
        • Park Y
        • Myerson M
        Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus.
        Foot Ankle Int. 1999; 20: 777-780
        • Root ML
        • Orien WP
        • Weed JH
        Motion of the joints of the foot: the first ray.
        in: Root SA Clinical Biomechanics. Volume II: Normal and Abnormal Function of the Foot. Clinical Biomechanics, Los Angeles1977 (46–51, 350–354)
        • Meyer JO
        • Nishon LR
        • Weiss L
        • Docks G
        Metatarsus primus elevatus and the etiology of hallux rigidus.
        J Foot Surg. 1987; 26: 237-241
        • Roukis TS
        Metatarsus primus elevatus in hallux rigidus: fact or fiction?.
        J Am Podiatr Med Assoc. 2005; 95: 221-228
        • Bouaicha S
        • Ehrmann C
        • Moor BK
        • Maquieira GJ
        • Espinosa N
        Radiographic analysis of metatarsus primus elevatus and hallux rigidus.
        Foot Ankle Int. 2010; 31: 807-813
        • Green DR
        Radiology and biomechanical foot types.
        in: Miller SJ Mahan KT Yu GU Camasta CA Reconstructive Surgery of the Foot and Leg, Update ’98. The Podiatry Institute, Tucker, GA1998: 292-315
        • Camasta CA
        Radiographic evaluation and classification of metatarsus primus elevatus.
        in: Camasta CA Reconstructive Surgery of the Foot and Leg, Update ’94. The Podiatry Institute, Tucker, GA1994: 122-127
        • Dickerson JB
        • Green R
        • Green DR
        Long-term follow-up of the Green-Watermann osteotomy for hallux limitus.
        J Am Podiatr Med Assoc. 2002; 92: 543
        • Laakmann G
        • Green RM
        • Green DR
        The modified Watermann procedure: a preliminary retrospective study.
        in: Camasta CA Reconstructive Surgery of the Foot and Leg: Update ’95. The Podiatry Institute, Tucker, GA1995: 128
        • Lambrinudi C
        Metatarsus primus elevatus.
        Proc R Soc Med. 1938; 31: 273
        • Davies GF
        Plantarflexory base wedge osteotomy in the treatment of functional and structural metatarsus primus elevatus.
        Clin Podiatr Med Surg. 1989; 6: 93-102
        • Vanore JV
        • Christensen JC
        • Kravitz SR
        • Schuberth JM
        • Thomas JL
        • Weil LS
        • Zlotoff HJ
        • Mendicino RW
        • Couture SD
        • Clinical Practice Guideline First Metatarasophalangeal Joint Disorders Panel of the American College of Foot and Ankle Surgeons
        Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: hallux rigidus.
        J Foot Ankle Surg. 2003; 42: 124-136
        • Drago JJ
        • Oloff L
        • Jacobs AM
        A comprehensive review of hallux limitus.
        J Foot Ankle Surg. 1984; 23: 213-220
        • Boffeli T
        • Collier RC
        Lateral stress dorsiflexion view: a case series demonstrating clinical utility in midterm hallux limitus.
        J Foot Ankle Surg. 2015; 54: 739-746
        • Sanchez PJ
        • Grady JF
        • Lenz RC
        • Park SJ
        • Ruff JG
        Metatarsus primus elevatus resolution after first metatarsophalangeal joint arthroplasty: eliminating elevatus without an osteotomy—a preliminary study.
        JAPMA. 2018; 108: 200-204
        • Lamm BM
        • Paley D
        Deformity correction planning for hindfoot, ankle and lower limb.
        Clin Podiatr Med Surg. 2004; 21: 305-326
        • Smith WB
        • Dayton P
        • Santrock RD
        • Hatch DJ
        Understanding frontal plane correction in hallux valgus repair.
        Clin Podiatr Med Surg. 2018; 35: 27-36
        • Mirmiran R
        • Wide B
        • Nielsen M
        Retrospective analysis of the rate and interval to union for joint arthrodesis of the foot and ankle.
        J Foot Ankle Surg. 2014; 53: 420-425