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Observation
1%
23/3212
Medial sesamoidectomy
25/3212
Cheilectomy and joint debridement
79%
2550/3212
1st MTP resection artrhoplasty (Keller procedure)
3%
104/3212
1st MTP fusion
15%
491/3212
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This patient has hallux rigidus, or arthritis of the first metatarsal phalangeal joint. He has moderate limitations in motion, and mild joint space narrowing on radiographs. Therefore, he would be classified as Type 2, and the most appropriate treatment would be cheilectomy and joint debridement. Coughlin et al broke hallux rigidus down into grades 0 thru 4, based on range of motion, radiographic, and clinical findings. They describe 97% good to excellent results with cheilectomy for grade 1 or 2 disease. Mann et al describe their excellent results (improved mobility and decreased pain) in treating 25 patients with cheilectomy and describe that cheilectomy offers a better functional treatment for hallux rigidus. They reported that no repeat surgery was needed at greater than 4 year follow up of cheilectomy. Illustration A shows the different grades described by Coughlin et al.
2.9
(39)
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