A subsequent group of 59 patients, with a mean age of 51 years, underwent first metatarsal decompression osteotomy and were reviewed at an average 15 months postoperatively. In the phalangeal osteotomy group, 65% of patients were completely satisfied, 24% were satisfied with reservation, and 11% were dissatisfied. Three patients suffered continued metatarsophalangeal joint pain, 3 developed hallux interphalangeal joint pain, and 4 patients developed transfer metatarsalgia.
The postoperative decrease from 36° to 35° in mean peak hallux dorsiflexion on walking was not significant. In the first metatarsal decompression osteotomy group, 54% were completely satisfied, 13.5% were satisfied with reservations, and 32% were dissatisfied. Continued metatarsophalangeal joint pain occurred in 2 patients, 18 developed transfer metatarsalgia, and 6 of these patients required lesser metatarsal osteotomy.
Peak hallux dorsiflexion during walking increased from 36° to 42° (P < .001). First metatarsal decompression osteotomy will increase joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy. Neither procedure could be considered definitive for hallux rigidus. Previous article Next article Key words Hallux limitus hallux rigidus osteotomy phalangeal metatarsal Check if you have access through your login credentials or your institution.
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Radiographs were measured both pre- and postoperatively to assess the 1-2 intermetatarsal angle, hallux abductus angle, and tibial sesamoid position (TSP). The mean amount of varus (supination) rotation performed during correction was 22.1° ± 5.2° and the mean amount of intermetatarsal angle reduction achieved after completion of the procedure was 6.9° ± 3.0°. The TSP changed by a mean of 3.
3° ± 1.2°. A series of univariate linear regression analyses was performed to analyze the relationship between the frontal plane rotation of the first metatarsal performed during the operation and the preoperative intermetatarsal angle, hallux abductus angle, and TSP. Greater preoperative TSP scores were associated with greater intraoperative varus (supination) rotation required for joint alignment.
Direct observation of the alignment changes at the first metatarsal phalangeal joint after metatarsal rotation without distal procedures strengthened the notion that the frontal plane rotational position plays an important role in the bunion deformity. Previous article Next article Level of Clinical Evidence 4 Keywords hallux abducto valgus Lapidus arthrodesis metatarsus primus adducto valgus metatarsal pronation tibial sesamoid position Check if you have access through your login credentials or your institution.
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