Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients.

The surgical options for hallux rigidus in the presence of painful but moderate degenerative metatarsophalangeal joint disease are limited to either joint-destructive or joint-preserving procedures. The following study compared the effectiveness of 2 joint-preservation procedures. Forty-nine patients, with a mean age of 53 years, underwent phalangeal osteotomy and were reviewed at an average 29 months postoperatively. 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 degrees to 35 degrees 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 degrees to 42 degrees (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.