[Minimally invasive cheilectomy].

OBJECTIVES

Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head.

INDICATIONS

Hallux rigidus grades II and III CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis.

SURGICAL TECHNIQUE

Osteophytes around the metatarsophalangeal joint are removed using a 1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with a burr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with a rangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy.

POSTOPERATIVE MANAGEMENT

Removal of the sutures after 2 weeks. Depending on pain, the patient can change from the postoperative shoe to a normal soft, comfortable and wide shoe after 1-2 weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended.

RESULTS

The technique allows a soft-tissue-preserving resection of the osteophytes and a partial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21 women and 17 men with hallux rigidus stages II and III (Vanore) underwent surgery. Minimum follow-up was 12 months. In 1 patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to a metatarsophalangeal fusion, while another patient received a resection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7 points.