Radical Cheilectomy as an Alternative to Arthrodesis for Hallux Rigidus

Hallux rigidus (HR) is a painful condition involving osteoarthrosis and reduced range of motion of the first metatarsophalangeal joint (MTPJ). It is associated with significant morbidity and reduced quality of life. We report a case of a 42-year-old female who had been referred to our surgical clinic regarding the progressively worsening chronic pain, stiffness and long-term shoe-fitting difficulties associated with her right HR pathology. Her vocational duties within the fashion industry necessitated the use of high heeled court-style shoes, and thus she maintained a preference for a procedure that would facilitate normal joint range of motion so that she could continue to wear this type of footwear. We performed a variation to a traditional cheilectomy procedure involving radical remodelling of the first metatarsal head to allow for up to 90 degrees of intraoperative dorsiflexion. The patient reported reduced pain and increased function up until her discharge at 12 weeks postoperatively. A radical cheilectomy may provide acceptable pain relief and improved joint function in patients with end-stage HR who decline the option of arthrodesis.

Keywords: arthroplasty; foot surgery techniques; forefoot; great toe; hallux disorders; joint preservation surgery.