Functional Outcome of Cheilectomy for the Treatment of Hallux Rigidus

Introduction: Cheilectomy is performed as treatment for hallux rigidus. Its aim is the relief of pain and improvement of function. Previous pedobarograhic studies have revealed that osteoarthritis of the first metatarsophalangeal joint leads to a lateralisation of peak forces during the stance phase of gait. This occurs since the big toe does not participate in push-off in a sufficient way. The results concerning functional outcome as well as subjective patient satisfaction were assessed in the present study. Plantar pressure distribution analysis was used in order to investigate functional outcome in a biomechanically objective way. Patients and Method: In this retrospective study 44 patients (52 feet) who underwent cheilectomy for the treatment of hallux rigidus were examined. There were 30 women and 14 men with a mean age of 60.1 years (range: 41-79). The average follow-up was 14.9 months (range: 6-40). The assessment included a four-stage subjective satisfaction rating scale, the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal score and first metatarsophalangeal joint (MTP) range of motion (ROM) measurements. In addition, dynamic plantar pressure distribution measurements were performed using the EMED system (Novel GmbH, Munich). The parameters maximum force (N), peak pressure (kPa), contact area (cm(2)), contact time (msec) and impulse (N x sec) were calculated for the geometric regions of interest great toe, second toe, first metatarsal head, second metatarsal head and total object. Statistical analysis was performed using paired student's t-test and level of significance was set at alpha < 0.05. Results: 27 patients have been very satisfied with the operation, for 10 patients the result of the operation has been satisfactory. The mean AOFAS score increased statistically significant from 35 points presurgery to 88 points postsurgery. First MTP ROM increased from 18.1 degrees before surgery to 49.1 degrees at follow-up. Isolated dorsiflexion increased from 21.4 degrees to 34.1 degrees (p = 0.0009) and isolated plantar flexion was 15.8 degrees presurgery and 16.9 degrees at follow-up (p = 0.214). Plantar pressure analysis revealed no significant difference between the foot that was operated and the non-operated foot for any region of interest or pedobarographic parameter Conclusion: Cheilectomy represents a reliable technique for hallux rigidus that can achieve good results in patient satisfaction and functional outcome. Since the resection of osteophytes improves kinematics of the first MTP joint the technique of cheilectomy may help to restore physiological gait patterns. This is represented by the pedobarographic results of the present study. In fact, they revealed a plantar pressure distribution that is reconstructed to a satisfactory extent, showing that the big toe is reintegrated into a physiological gait pattern.