Hallux rigidus: the long-term results of dorsal wedge osteotomy and arthrodesis in adults.

A variety of treatments are recommended for hallux rigidus. These include arthrodesis of the first metatarsophalangeal joint and dorsal wedge osteotomy of the proximal phalanx. This latter operation is not commonly performed in adults. A retrospective review of a series of 10 osteotomies and 20 arthrodeses after an average of 12 years for hallux rigidus in the adult was undertaken. Patients were assessed at a follow-up clinic and their foot pressures were analyzed. Although the two groups were not matched, some conclusions could be drawn. Both operations were successful in terms of pain relief. Complications were more common after arthrodesis. Callosities were more common after arthrodesis. A greater duration of load occurs toward the fifth metatarsal after arthrodesis. A greater force occurs under the first metatarsal after an osteotomy rather than an arthrodesis. It was concluded that the dorsal wedge osteotomy is an alternative operation for hallux rigidus in the adult, provided that there is some plantarflexion possible at the metatarsophalangeal joint. It is recommended as a procedure to preserve movement at the metatarsophalangeal joint to prevent callosities. If the osteotomy fails to relieve symptoms, then an arthrodesis can be performed as a salvage procedure.