Surgery for hallux rigidus

NewsBot · May 29, 2025

Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis
Ryan Sanii et al
Foot Ankle Orthop. 2025 Mar 29;10(1):24730114251324184.

Background: A modern technique for the treatment of hallux rigidus (HR) is first metatarsophalangeal (MTP) hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. Current scientific literature reporting early outcomes of the procedure is sparse and mixed, indicating the need for further analysis. The objective of this study was to compare improvement in visual analog scale (VAS) scores with first MTP hemiarthroplasty with Cartiva implant (HI), allograft interposition arthroplasty (IA), and arthrodesis (A) in patients who failed conservative management or cheilectomy.

Methods: A retrospective cohort study of 99 patients was performed. There were 49 patients in the HI group, 25 patients in the IA group, and 25 patients in the A group. A follow-up survey was administered from which updated VAS and updated American Orthopaedic Foot & Ankle Society scores were obtained.

Results: Mean VAS scores improved by 2.73 (SD ± 2.80) points in the HI group, 4.16 (SD ± 2.01) points in the IA group, and 4.36 (SD ± 3.67) points in the A group (P = .035). Mean AOFAS scores improved by 14.90 (SD ± 17.31) points in the HI group, 27.80 (SD ± 15.22) points in the IA group, and 27.88 (SD ± 25.34) points in the A group (P = .005). There were 3 (6.1%) revision surgeries in the HI group, 2 (8.0%) revision surgeries in the A group, and no revision surgeries in the IA group (P = .59). Within the HI group, all 3 revisions were due to pain associated with the implant and were revised to MTP arthrodesis. The A group had 1 revision due to broken hardware and 1 revision due to infection. In both cases, the patients were treated with hardware removal.

Conclusion: Pain and function may be slightly more improved with interpositional arthroplasty and arthrodesis for the treatment of HR, when compared to hemiarthroplasty with the Cartiva implant.
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NewsBot · Jun 5, 2025

Minimally Invasive vs Open First Metatarsophalangeal Joint Cheilectomy: Radiographic Outcomes and Early Complications
Noopur Ranganathan
Arch Bone Jt Surg. 2025;13(3):152-156.

Objectives: Current literature on surgical techniques has evaluated minimally invasive surgery (MIS) cheilectomy and its efficacy in comparison to the open technique. However, no study to date has evaluated MIS-Moberg in relation to open and MIS cheilectomy. This study assessed radiological outcomes and early healing and complications of patients who underwent open, MIS, and MIS-Moberg cheilectomies.

Methods: We conducted a retrospective cohort review of 134 patients who underwent first metatarsophalangeal (MTP) cheilectomy at an academic medical center between 2015 and 2024. Success of cheilectomy was determined radiographically. Postoperative complications were identified through medical record review.

Results: 73 open and 61 MIS cheilectomies were performed on 134 patients with a primary diagnosis of hallux rigidus. The pre-operative versus post-operative differences in dorsal cortical length (3.7±1.4) and sagittal articular P1 angle (7.3±4.8) were found to be statistically significant (P<0.05) for the MIS-Moberg group. Ten patients in the open cheilectomy were found to have dorsiflexion and plantarflexion stiffness compared to zero patients in the MIS and MIS-Moberg groups (P<0.01).

Conclusion: We showed a significantly greater rate of plantar- and dorsiflexion stiffness in open surgeries compared to MIS and MIS-Moberg. No other differences in healing rates or radiologic outcomes were observed. Based on preliminary results, the MIS-Moberg can successfully alter the radiographic alignment of the great toe and does not increase complications as compared to open or MIS cheilectomy alone.
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NewsBot · Jun 5, 2025

Defining the patient acceptable symptom state (PASS) for PROMIS after Hallux Rigidus correction surgery
Allison L. Boden et al
Source

It is unclear which patient reported outcome metric correlates best with clinical improvement. The patient acceptable symptom state (PASS) incorporates the patient's subjective outcome experience into the outcome measurement. This study aims to establish PASS thresholds using Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients undergoing hallux rigidus (HR) correction. A retrospective review of prospectively collected data identified 144 patients who were treated surgically for HR between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS scores, and had responses to two distinct PASS anchor questions. PASS thresholds were determined using the maximum Youden Index. Differences in demographic and surgical characteristics between patients who met or did not meet the PASS thresholds were compared using independent samples T-tests and Pearson Chi-Square tests. Overall, 70 % of patients met the PASS thresholds. Patients with better baseline PROMIS scores were more likely to meet the postoperative PASS thresholds for every PROMIS domain (p < 0.05). Patients who did not undergo first metatarsophalangeal (MTP) fusion were more likely to reach the PASS threshold for the Physical Function domain (p = 0.045). For the Pain Intensity domain, younger patients were more likely to meet the thresholds (p = 0.005). Patient sex, BMI, and use of either cheilectomy or Akin/Moberg osteotomy during surgery did not impact a patient's likelihood of meeting the PASS thresholds. After surgical intervention for HR, it may not be necessary for patients to reach normal physical function or pain levels in order to reach an acceptable postoperative symptom state.
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NewsBot · Jun 11, 2025

Rate of Subsequent Hallux Interphalangeal Joint Fusion After First Metatarsophalangeal Fusion: A National Database Study with Verified Continued Patient Enrollment
Eslam Alkaramany et al
Foot Ankle Int. 2025 Jun;46(6):629-632.

Background: The risk of symptomatic degeneration at the interphalangeal (IP) joint after arthrodesis of the hallux metatarsophalangeal (MTP) joint remains undetermined and is a common question from patients considering the procedure. This study investigated the rate of subsequent hallux IP joint fusion after first MTP joint arthrodesis.

Methods: Patients who underwent hallux MTP joint arthrodesis were identified from a large national commercial insurance database (PearlDiver) by Current Procedural Terminology (CPT) code. Patients who underwent first IP fusion were also identified. To ensure continued enrollment of patients, the subset of patients with verified insurance claims in the database for all of the subsequent 10 years were analyzed. The Kaplan-Meier curve for survivorship free of subsequent IP fusion was generated covering 10 years from the index operation.

Results: Of 15,771 patients with MPT joint arthrodesis active on the database to 10 years, 166 had IPJ fusion after MPT joint fusion. The risk of undergoing IP fusion within 10 years after a previous first MTP fusion was 1.052% (95% CI 0.9%-1.1%). The mean time between the 2 procedures was 4.0 years. Because CPT codes in the database were reported without laterality, a small subset of patients may have undergone subsequent contralateral IP fusion. Therefore, this result should be regarded as an upper limit of the estimated rate.

Conclusion: The rate of subsequent hallux IP joint fusion of around 1% within 10 years after a first MTP joint fusion in this large database population highlights the durability of the clinical result of first MTP joint fusion and should reassure patients and surgeons considering the procedure.
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NewsBot · Jun 14, 2025

Short-Term Outcomes of First Metatarsophalangeal Arthroplasty Using the Silktoe Double-Stemmed Silicone Implant
Stefano Fieschi et al
Diagnostics (Basel). 2025 May 27;15(11):1349.

Background: Hallux rigidus is a painful and degenerative pathology of the first metatarsophalangeal (MTP1) joint. In severe cases it is usually appropriate to consider arthrodesis or arthroplasty of the joint. Arthrodesis represents the gold standard, but arthroplasty allows patients to recover mobility. Although arthroplasty has slightly inferior functional results to arthrodesis, it has shown very good results in terms of joint mobility, patient satisfaction and pain reduction. The goal of the present study was to evaluate short-term outcomes of patients that received a third-generation double-stemmed MTP1 implant manufactured from high-performance silicon. Methods: In this retrospective study the authors analyzed data of 37 patients who underwent MPT1 joint arthroplasty with SilktoeTM double-stemmed implant using the R 4.2.2 software (R Foundation for Statistical Computing, Vienna, Austria). The indications were hallux rigidus of grade III and grade IV (81.1%), hallux rigidus plus valgus (10.8%), painful or unstable joint following previous surgery (5.4%) and hallux rigidus due to gout (2.7%). Data were collected during routine visits at 1 and 6 months and 1 and 2 years. Results: There were no intraoperative and postoperative complications. There were no revisions or reoperations at a follow-up of two years. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS-HMI) score was 94.6 ± 7.6 (median, 100; range, 70-100) and the Visual Analogue Scale (VAS) score was 0.4 ± 0.80 (median, 0; range, 0-3.5) at the final follow-up. Conclusions: The data from this study presented excellent short-term results for patients who received an arthroplasty of the MTP1 joint using a third-generation double-stemmed spacer made of high-performance silicone. For all patients who received the SilktoeTM implant, AOFAS-HMI scores of 94.6 and VAS scores of 0.4 were obtained at a two-year follow-up. These values were in line with results reported in the literature for similar devices.
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NewsBot · Jun 19, 2025

Medial Sesamoidectomy as a Local Autograft Source in Revision or Complex First Metatarsophalangeal Joint Arthrodesis
Aaron Tran et al
Foot Ankle Orthop. 2025 Jun 16;10(2):24730114251343071.

Background: Arthrodesis of the first metatarsophalangeal (MTP) joint is a well-established procedure with excellent outcomes for patients with forefoot disorders. Routine bone grafting is not typically required, but bone graft may be necessary in the setting of revision surgery. Because of potential harvesting morbidity and time associated with an extra incision, allograft bone is frequently used. In this study, we describe the outcomes of an approach to first MTP fusion with simultaneous medial sesamoidectomy for utilization as autograft.

Methods: A retrospective review of all first MTP arthrodesis cases performed by one fellowship-trained foot and ankle surgeon were identified. Operative reports and radiographs were reviewed identifying patients who underwent simultaneous medial sesamoidectomy for autograft purposes. Indications for sesamoidectomy harvesting were noted. The primary outcome reviewed was fusion rate. Overall nonunion rates and patient outcomes were collected and compared between those undergoing sesamoidectomy for grafting and those undergoing standard procedure arthrodesis.

Results: A total of 107 patients underwent first MTP arthrodesis. Of these, 24 underwent concurrent sesamoidectomy grafting with 9 requiring additional calcaneal grafting. Indications for the sesamoidectomy group included 5 primary cases of erosive hallux rigidus, 2 cases of hallux valgus, 6 nonunions, 3 failed Cartiva implants, 2 cases of avascular necrosis, 4 failed arthroplasties, and 2 conversion bunionectomy. All 24 patients in the sesamoidectomy group achieved successful union. For context, the broader cohort undergoing first MTP arthrodesis had a fusion rate of 92.1%. All patients in the sesamoidectomy group were satisfied with their surgical outcome.

Conclusion: This study found highly successful fusion rates in a potentially higher risk population with the use of local autografting from the medial sesamoid. The medial sesamoid serves as a freely available, structurally supportive graft material for first MTP arthrodesis that can be readily harvested via the same incision, potentially reducing the need for additional graft sites. However, given the retrospective nature, single-surgeon cohort, and small sample size, further studies are warranted to confirm these findings and evaluate comparative outcomes.
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NewsBot · Jun 28, 2025

Great Toe Joint Hemi-Implant Failure
A Case of Cobalt Metal Allergy
James J. DiResta and Angela Barnes

Hemi-joint implants for treatment of osteoarthritis of the great toe joint have been known to fail at times from a variety of reasons and often requires a return to the operating room for removal and/or conversion. We present an interesting case of a cobalt hemi-implant failure from metal allergy 16 months after implantation. This is an underreported event in podiatric literature. We present an interesting discussion, as we feel a review of metal allergy occurrence with joint implant replacement, whether preoperative screening, patch testing, or lymphocyte transformation testing might be of value. We encourage foot and ankle surgeons to include implant allergy in their differential diagnosis as a possible cause of implant failure.
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NewsBot · Jun 29, 2025

Biomechanical Comparison Between Fixation Techniques for First-Metatarsophalangeal Joint Arthrodesis
Chase M. Romere et al
Source

Background:
Metatarsophalangeal (MTP) arthrodesis is the gold standard for treatment of end-stage degeneration or severe hallux valgus deformities. Traditional fixation uses stainless steel or titanium plates, often with a crossing screw. Nitinol, a superelastic nickel-titanium alloy, offers dynamic compression. Nevertheless, it is unknown how nitinol implantation in the context of first-MTP arthrodesis performs biomechanically. We hypothesized that nitinol constructs would demonstrate biomechanical performance comparable or superior to a traditional plate-and-screw construct.
Methods:
Twelve pairs of cadaveric metatarsophalangeal joints were organized into 3 groups according to a balanced incomplete block design: (1) a traditional titanium plate and cross-screw (PS) construct, (2) a nitinol staple and cross screw (NSS) construct, and (3) a proprietary nitinol hybrid screw (NHS) construct. The PS construct consisted of a plate with a compression cross screw; the NSS construct consisted of a nitinol staple with a compression cross screw; and the NHS construct consisted of a hybrid nitinol staple with a compression cross screw. Each specimen was cyclically loaded over 100 cycles at 1 Hz from 20 to 90 N followed by failure testing. A high-definition camera recorded gapping. Failure load, deflection, and stiffness were recorded.
Results:
Compared with the PS construct, both nitinol constructs (NSS and NHS) demonstrated significantly higher failure loads (NSS: 196 ± 101 N, P = .011; NHS: 161 ± 45 N, P = .045), greater stiffness (NSS: 33 ± 15 N/mm, P = .012; NHS: 29 ± 12 N/mm, P = .042), reduced deflection after cyclic loading (NSS: 6 ± 3 mm, P = .047; NHS: 7 ± 3 mm, P = .048), and decreased gapping at failure (NSS: 1 ± 1 mm, P = .003; NHS: 2 ± 1 mm, P = .008). No significant differences were observed between NSS and NHS.
Conclusion:
Nitinol constructs for MTP arthrodesis demonstrated superior mechanical performance compared with a traditional plate-and-screw construct, with higher failure load and stiffness.
Clinical Relevance:
These results support the growing use of nitinol for joint fusion, highlighting its potential to improve load to failure and reduce displacement under cyclic loading.
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NewsBot · Jul 15, 2025

Hallux Rigidus with an Increased or Equal First Metatarsal Length after a Cheilectomy and First Metatarsal Shortening Osteotomy (FMSO) Using a Small Shortening Scarf: A Retrospective 7-year Clinical and Gait Analysis Follow-up
Karl-Heinz Kristen et al
Source

Background
In hallux rigidus, the relative length of the first metatarsal has been implicated in its pathogenesis, suggesting a potential benefit from combined surgical approaches.
Purpose
To evaluate the long-term outcomes of a combined surgical approach using cheilectomy and shortening SCARF osteotomy for moderate hallux rigidus (Coughlin grades 2-3) in active patients with a first metatarsal index equal to or longer than the second metatarsal.
Study Design
Retrospective cohort study.
Methods
Twenty-three feet in 20 patients (mean age 49.4 ± 8.4 years) underwent combined cheilectomy and 4-mm shortening SCARF osteotomy. Outcomes were assessed at a mean follow-up of 6.7 ± 2.5 years using the American Orthopedic Foot and Ankle Society and European Foot and Ankle Surgery scores, range of motion, and gait analysis.
Results
American Orthopedic Foot and Ankle Society scores improved from 32.2±11.7 preoperatively to 86.6±6.2 at the follow-up, and European Foot and Ankle Surgery scores increased from 13.8±2.8 perioperatively to 35.4±3.9 at the follow-up. The total range of motion increased from 32.8° to 44.7° ±16,3°. Gait analysis revealed a physiological plantar pressure distribution at follow-up. Complications included the recurrence of joint stiffness and pain in three patients and transient transfer metatarsalgia in one patient.
Conclusion
Shortening SCARF osteotomy plus mild cheilectomy may be an effective joint-preserving procedure in patients with first metatarsal overlength, with results comparable to those of cheilectomy and other first metatarsal shortening osteotomies.
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NewsBot · Jul 16, 2025

Outcomes Following Minimally Invasive vs Open Cheilectomy for Hallux Rigidus: A Systematic Review
Caroline Cristofaro et al
Foot Ankle Spec. 2025 Jul 2:19386400251345538.

IntroductionHallux rigidus is common and can be disabling for patients. Once conservative management is exhausted, surgical treatment is considered. For earlier stage hallux rigidus, cheilectomy can be offered to patients. Traditionally, open cheilectomy has been performed, but minimally invasive cheilectomy is becoming increasingly popular. The purpose of this systematic review is to compare the outcomes of minimally invasive vs open cheilectomy for hallux rigidus.MethodsTwo comprehensive literature searches of Ovid MEDLINE and EMBASE were performed for relevant publications from January 1, 1995 to April 9, 2024. Search terms focused on open and minimally invasive surgery (MIS) cheilectomy were used. All full-text, English-language, clinical studies reporting on MIS and open cheilectomy outcomes and/or complications were included. Article screening, critical appraisal, and data extraction were performed independently by 2 reviewers.ResultsNine MIS cheilectomy studies were identified, reporting on a total of 442 patients (95 males, 214 females, and 133 not reported) with 464 feet operated on. The weighted mean age and follow-up were 50.7 ± 4.6 years and 33. 5 ±14.0 months, respectively. Fifteen open cheilectomy studies were identified, yielding 720 patients (199 males, 319 females, and 202 not specified) and 763 operated feet. The weighted mean age and follow-up was 53.2 ± 4.7 years and 64.5 ± 28.3 months, respectively. Functional outcomes are similar following open or MIS cheilectomy. The MIS cheilectomy studies reported a total of 37 complications (8.2%) and 43 revision surgeries (9.3%). Complications and revision surgery following open cheilectomy were 14.7% (n = 112) and 5.0% (n = 38), respectively. Complications following open cheilectomy were higher than with MIS cheilectomy (P = .001). However, revision surgery was found to be higher in patients following MIS cheilectomy (P = .003).ConclusionSurgical complications following MIS cheilectomy were found to be less common when compared to open cheilectomy. However, there may be an increased risk of revision surgery following MIS cheilectomy
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NewsBot · Jul 20, 2025

Fifteen-Year Follow-up of the Modified Oblique Keller Capsular Interposition Arthroplasty Compared to Arthrodesis for Treatment of Advanced First Metatarsophalangeal Joint Arthritis
Jeffrey E Johnson et al
Foot Ankle Orthop. 2025 Mar 20;10(1):24730114251322766.

Background: Although metatarsophalangeal joint (MTPJ) arthrodesis is considered the "gold standard" for treatment of advanced MTPJ arthritis, a modified oblique Keller capsular interposition arthroplasty (MOKCIA) is an alternative treatment for hallux rigidus that retains MTPJ motion. We aim to retrospectively compare long-term patient-reported outcomes, radiographic alignment, MTPJ walking kinematics, and plantar pressure between the MOKCIA and MTPJ arthrodesis for advanced hallux rigidus.

Methods: Thirty-five patients were recruited from a retrospective chart review (MOKCIA [n = 15, average 15 years from surgery] or an arthrodesis [n = 20, average 13 years from surgery]). We measured visual analog scale (VAS) pain and satisfaction, Foot and Ankle Ability Measure (FAAM), Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scores, radiographs, walking MTPJ sagittal plane kinematics, forefoot, and first toe peak plantar pressure during walking, MTPJ goniometer range of motion, and need for additional surgery. Two-sample t tests or χ2 were used to compare groups. A Spearman correlation was used to examine the relationships between measured variables.

Results: Groups did not differ on demographic characteristics, FAAM activities of daily living scale (MOKCIA = 94 ± 8, arthrodesis = 94 ± 7, P = .93), PROMIS physical function T-score (MOKCIA = 50 ± 6, arthrodesis = 48 ± 6, P = .41), forefoot, and first-toe walking peak plantar pressure. The MOKCIA had small but significantly lower VAS pain (MOKCIA = 0.1 ± 0.3, arthrodesis = 1.0 ± 1.6, P = .02) and higher satisfaction scores (MOKCIA = 9.5 ± 0.9, arthrodesis = 8.4 ± 1.8, P = .03). MTPJ passive arc of excursion in the MOKCIA group was 44 ± 15 degrees, and greater goniometric measured flexion of the first MTPJ correlated with greater patient satisfaction in the MOKCIA group (ρ = 0.70, P < .01). No MOKCIA patient in our study group required additional surgery.

Conclusion: Patients in both the MOKCIA and arthrodesis groups reported high function with little limitation due to their toe surgery. Patients in the MOKCIA group had similar pain and satisfaction compared with the arthrodesis group. These results suggest MOKCIA is a joint range of motion-preserving alternative to MTPJ arthrodesis for long-term treatment of hallux rigidus.
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NewsBot · Jul 23, 2025

Comparative Outcomes of First Metatarsophalangeal Arthrodesis in Hallux
Valgus Versus Hallux Rigidus.
Ertan MB, Yuncu M, Buyukarslan V, Etli I, Kose O.
Eur Arch Med Res 2025;41(1):41–48.
Objective: This study aimed to compare the functional and radiological outcomes of first metatarsophalangeal (MTP) joint
arthrodesis in patients with hallux valgus (HV) and hallux rigidus (HR).
Materials and Methods: This retrospective cohort study included 78 feet (39 HV and 39 HR) that underwent first MTP
arthrodesis between 2015 and 2023. Data collected included demographic information, surgical technique, radiological
measurements (hallux valgus angle and intermetatarsal angle), union rates, and clinical outcomes assessed by the American
Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale for pain. Statistical analyses compared outcomes
between the HV and HR groups.
Results: Post-operative AOFAS scores demonstrated no significant difference between the HV and HR groups (p=0.236).
Union rates were comparable (87.2% in HV vs. 89.7% in HR, p=0.500). Complication rates, including implant failure and
superficial infection, were low and similar between the groups. One symptomatic non-union was observed.
Conclusion: The findings indicate that first MTP arthrodesis yields comparable functional outcomes, union rates, and low
complication rates in patients with both HV and HR. These outcomes support the efficacy of the procedure irrespective of
the underlying pathology.

NewsBot · Jul 23, 2025

Comparative Outcomes of First Metatarsophalangeal Arthrodesis in Hallux
Valgus Versus Hallux Rigidus.
Ertan MB, Yuncu M, Buyukarslan V, Etli I, Kose O.
Eur Arch Med Res 2025;41(1):41–48.

Objective: This study aimed to compare the functional and radiological outcomes of first metatarsophalangeal (MTP) joint
arthrodesis in patients with hallux valgus (HV) and hallux rigidus (HR).
Materials and Methods: This retrospective cohort study included 78 feet (39 HV and 39 HR) that underwent first MTP
arthrodesis between 2015 and 2023. Data collected included demographic information, surgical technique, radiological
measurements (hallux valgus angle and intermetatarsal angle), union rates, and clinical outcomes assessed by the American
Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale for pain. Statistical analyses compared outcomes
between the HV and HR groups.
Results: Post-operative AOFAS scores demonstrated no significant difference between the HV and HR groups (p=0.236).
Union rates were comparable (87.2% in HV vs. 89.7% in HR, p=0.500). Complication rates, including implant failure and
superficial infection, were low and similar between the groups. One symptomatic non-union was observed.
Conclusion: The findings indicate that first MTP arthrodesis yields comparable functional outcomes, union rates, and low
complication rates in patients with both HV and HR. These outcomes support the efficacy of the procedure irrespective of
the underlying pathology.
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NewsBot · Jul 23, 2025

Comparative Outcomes of First Metatarsophalangeal Arthrodesis in Hallux
Valgus Versus Hallux Rigidus.
Ertan MB, Yuncu M, Buyukarslan V, Etli I, Kose O.
Eur Arch Med Res 2025;41(1):41–48.

Objective: This study aimed to compare the functional and radiological outcomes of first metatarsophalangeal (MTP) joint
arthrodesis in patients with hallux valgus (HV) and hallux rigidus (HR).
Materials and Methods: This retrospective cohort study included 78 feet (39 HV and 39 HR) that underwent first MTP
arthrodesis between 2015 and 2023. Data collected included demographic information, surgical technique, radiological
measurements (hallux valgus angle and intermetatarsal angle), union rates, and clinical outcomes assessed by the American
Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale for pain. Statistical analyses compared outcomes
between the HV and HR groups.
Results: Post-operative AOFAS scores demonstrated no significant difference between the HV and HR groups (p=0.236).
Union rates were comparable (87.2% in HV vs. 89.7% in HR, p=0.500). Complication rates, including implant failure and
superficial infection, were low and similar between the groups. One symptomatic non-union was observed.
Conclusion: The findings indicate that first MTP arthrodesis yields comparable functional outcomes, union rates, and low
complication rates in patients with both HV and HR. These outcomes support the efficacy of the procedure irrespective of
the underlying pathology.
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NewsBot · Jul 23, 2025

Comparison outcomes of cheilectomy, hemi-implant arthroplasty and decompression osteotomy for the treatment of hallux rigidus: A retrospective study of 153 patients
Ashley A. Mariano DPM et al
The Journal of Foot and Ankle Surgery 22 March 2025

This retrospective case series investigated the treatment outcomes for hallux rigidus. A total of 153 patients (130 females, 49 males) were included. Of the 153 patients, 26 were bilateral and 179 procedures met the inclusion criteria. The patients had undergone 1 of the following procedures: cheilectomy (Group 1), hemi-implant arthroplasty (Group 2), decompression metatarsal osteotomy (DMO) (Group 3), and DMO with hemi-implant (Group 4). Mean patient age was 57 years (range 18-82), and the mean follow-up period was 26 months (range 12-72). All patients regardless of procedure had improvement in pain score with Group 4 demonstrating the greatest reduction in pain at 99 %. The majority of patients in the study had Stage II hallux limitus/rigidus (HL/HR) (67 patients), followed by 62 patients with Stage III and 49 patients with Stage IV. Preoperatively, the majority of patients lacked dorsiflexion at the first metatarsophalangeal joint. Group 1 gained 16° in dorsiflexion from preoperative to postoperative, Group 2 gained 20°, Group 3 gained 30° and Group 4 gained 24° by the 12 month followup. The results revealed that adhesions were the most common complication for all 4 surgical groups. These four surgical procedures for the treatment of Stage II, III and IV hallux rigidus are viable options and lead to satisfactory long-term outcomes that restore function, relieve pain and improve joint range of motion. Each procedure has demonstrated satisfactory long-term outcomes and high patient satisfaction.
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NewsBot · Jul 25, 2025

Joint Preservation in Hallux Rigidus: Evaluating the Efficacy of Modified Chevron Osteotomy with extensive Cheilectomy
Héctor José Masaragian, M.D.et al
Source

Background
: Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint, more frequently affecting females and individuals over 40 years. Various surgical options exist, but no prior studies have reported outcomes for distal shortening chevron osteotomy combined with extensive dorsal cheilectomy.
Purpose
: To evaluate the clinical and functional outcomes of patients with hallux rigidus treated with distal shortening chevron osteotomy and extensive dorsal cheilectomy.
Study Design
: Retrospective case series.
Methods
: A total of 50 patients (51 feet) underwent surgery between 2015 and 2022. One patient had bilateral involvement. The mean age was 49.37 years; 46% were male and 54% female. Mean follow-up was 46.57 months (range, 6–81 months). Patients were assessed preoperatively and after surgery using the American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion (ROM), Visual Analogue Scale (VAS), and Foot and Ankle Ability Measure (FAAM).
Results
: Postoperative scores demonstrated statistically significant improvements across all measures. Patients reported decreased pain, improved joint mobility, and enhanced function. The majority expressed satisfaction and indicated a willingness to undergo the procedure again.
Conclusion
: Distal shortening chevron osteotomy with extensive dorsal cheilectomy is a safe and effective surgical option for Coughlin grades I–III hallux rigidus. This technique yields consistent improvements in pain, mobility, and function, with high patient satisfaction.
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NewsBot · Aug 6, 2025

Return to Sport After Osteotomy in patients with Hallux Rigidus
P. Ceccarini et al
Foot and Ankle Surgery 6 August 2025

Introduction
Hallux rigidus (HR) is a common degenerative condition of the first metatarsophalangeal joint (MTPJ), particularly limiting in active adults and athletes. While joint-sacrificing procedures such as arthrodesis are effective, joint-preserving techniques remain preferable in patients wishing to maintain function and mobility. The modified Youngswick osteotomy offers such an option by decompressing and realigning the joint.
Methods
This retrospective observational study included 55 physically active patients (mean age: 42.8 ± 8.5 anni years) with grade II HR who underwent modified Youngswick osteotomy between 2015 and 2022. Inclusion criteria included active engagement in sports, age under 60 years, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), the European Foot and Ankle Society (EFAS) score, and return to sports (RTS) rates.
Results
At a mean follow-up of 79.3 months, 49 of 52 patients (94.2%) resumed sports activities. Significant improvements were observed in VAS scores (from 5.04 to 0.9, p<.001) and EFAS general (22.7 ± 6.1 to 37.1 ± 5.4, p<.001) and sport-specific scores (9.3 to 14.3, p<.001). Postoperative dorsiflexion improved from a mean of 24.5° to 52.5° (p<.001). Complications were rare and mild, including two cases of transfer metatarsalgia and one hardware intolerance.
Conclusion
Modified Youngswick osteotomy is an effective joint-preserving surgical option for moderate HR in active adults. It provides excellent pain relief, improves function and range of motion, and allows for a high rate of return to sports. This technique represents a valid alternative to arthrodesis in patients wishing to maintain MTPJ mobility and an active lifestyle.
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NewsBot · Sep 17, 2025

An Evidenced Based Review of the Efficacy of Fixation Type and Post Operative Weight-bearing Status on Metatarsophalangeal Joint Fusion for Treatment of Hallux Rigidus
Scott D. Purdie et al
Foot and Ankle Surgery 16 September 2025

Background
First metatarsophalangeal joint (MTP) arthrodesis is a common operative management for end-stage hallux rigidus. The purpose of this study is to present an evidence-based literature review and evaluation of the literature regarding the efficacy of different fixation methods and postoperative weight-bearing status for first MTP Arthrodesis.
Methods
A comprehensive literature review was conducted across three databases: Medline, Embase, and Cochrane, in September 2024. Exclusion criteria included biomechanical, cadaveric, and non-human studies, review articles, letters, and technical tips. The included articles were analysed and categorised according to their level of evidence (level I-V). A grade of recommendation (A, B, C, or I) in favour of or against each modern fixation method and weight-bearing status for first MTP arthrodesis for hallux rigid was determined by collective review of the categorised articles.
Results
86 of the 1390 identified articles were included. There is fair evidence (grade B) for fixation with screws, plates, and plate with a compression screw, as well as both immediate postoperative weight-bearing and non-weight-bearing, according to the current literature. Insufficient evidence (grade I) for staple and novel fixation methods exists.
Conclusions
The results of this comprehensive review provide the most up-to-date recommendations for fixation and postoperative protocol for surgical management of first MTP arthritis. The best available published peer-reviewed literature demonstrates that both immediate weight-bearing or non-weight bearing are viable postoperative protocols for first MTP arthrodesis, giving similar clinical outcomes. Additionally, the literature supports the use of screws, plates and plates with a compression screw as fixation methods. It is evident that additional high-quality level I and II studies are required to compare and validate these fixation methods and weight-bearing statuses to allow for stronger recommendations.
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NewsBot · Sep 20, 2025

Outcomes after Hallux Rigidus surgery: Are we measuring what is important to patients? A qualitative analysis of patient-identified outcomes
Alison W. Henderson et al
Source

Background

Hallux rigidus (HR) is the most common form of arthritis in the foot. The joint pain and loss of motion from HR experienced during walking may lead to a significant reduction in activity and quality of life, and advanced cases may require surgery. HR surgical outcomes are often evaluated quantitatively with more generic measures not designed specifically to assess HR outcomes. The goal of these study was to determine outcomes that are important to patients with HR, possibly those that are not addressed by more general foot and ankle measures.
Methods

Semi-structured interviews with HR surgical patients 4–9 years after surgery were conducted. Interviews were analyzed using a team-based, iterative inductive-deductive approach to identify outcomes important to patients.
Results

Ten patients were interviewed; five who received motion-sparing surgery and five with fusion surgery. From interviews, seven themes were identified: pain, first MTPJ motion, walking ability, physical activity, footwear, forefoot appearance, and pain in other areas of the body.
Conclusions

Post-HR surgery patients indicated outcomes of importance that are not addressed by more general instruments. Specifically, forefoot appearance and pain in other areas of the body are not addressed by commonly used instruments. In addition, patient experiences of pain are more granular and HR-specific than the generic pain items used by other instruments. Patients facing HR surgery may benefit from outcome measures that are more specific to the HR surgical experience and include outcomes that patients share are important to them that are not included in commonly used outcome instruments.
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NewsBot · Oct 1, 2025

Clinical Outcomes of First Metatarsophalangeal Joint Arthrodesis Using the BOFAS Registry: A Prospective Cohort Study
Ferozkhan Jadhakhan et al
J Foot Ankle Res. 2025 Dec;18(4):e70084.

Background: This study investigated the quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry first metatarsophalangeal joint (MTPJ) arthrodesis pathway.

Methods: A prospective cohort study using data derived from the BOFAS registry. Adults aged ≥ 18 years with a record of undergoing first MTPJ arthrodesis in the UK from 29/08/2014 to 31/10/2019. The pre- and post-treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) at baseline, 6 months and 12 months intervals. Consistency of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables.

Results: The mean age of the study population (n = 459) was 64.1 (± 12.1) years and 98.9% of the study cohort were female. Completeness of data collection was low for some items (e.g., medication 46%, surgical procedures 52%). Baseline completion of PROMs was moderate with 52.5% of participants providing MOXFQ (Manchester-Oxford Foot Questionnaire) pain and walking/standing scores at baseline. However, follow-up response rates declined substantially to 27.2% at 6 months and 15.7% at 12 months. Improvement in PROMs by 12 months following surgery was statistically and clinically significant (p < 0.001), with median scores of 10 [IQR: 0-20] for MOXFQ pain, 5.5 [0-21] for walking/standing, 0 [0-19] for social interaction, 5 [1-31] for NRS pain and 0.8 [0.7-1.0] for EQ-5D-5L.

Conclusion: The analysis highlights the clinical benefits of first metatarsophalangeal joint (first MTPJ) fusion surgery, with improvements in pain intensity, walking/standing ability, social interaction and quality of life. The BOFAS registry serves as a valuable tool for collecting patient-reported outcome measure (PROM) data, providing important insights into treatment effectiveness and participant well-being. Strengthening the data collection capabilities of the BOFAS registry could further enhance our understanding of the benefits of first MTPJ fusion and inform future treatment strategies.
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NewsBot · Oct 17, 2025

Return to sport after arthrodesis and implant arthroplasty for hallux rigidus : a systematic review
Thomas Stumpner, Stephan Obermayr, George Abdel-Nour, Simon Recheis, Michael Stephan Gruber & Reinhold Ortmaier
Archives of Orthopaedic and Trauma Surgery

Background

Painful, degenerative stiffening of the first metatarsophalangeal (MTP-1) joint, as seen in hallux rigidus, is common among athletic individuals due to repetitive microtrauma. While arthrodesis of the MTP-1 joint is considered the gold standard for advanced degeneration, the resulting loss of motion may impair sports and recreational activities. Implant arthroplasty, by preserving joint mobility, may offer functional benefits for active patients.
Methods

In accordance with PRISMA guidelines, a comprehensive literature search was conducted using PubMed, LIVIVO, the Cochrane Controlled Trials Library, Science Direct, CINHAL and Scopus. Studies reporting on sports function after MTP-1 arthrodesis or implant arthroplasty for degenerative arthritis were included. Fifteen studies with 1,103 procedures met the inclusion criteria. Sport-specific outcomes and functional scores were extracted and analyzed.
Results

Data on sports function following MTP-1 arthrodesis and implant arthroplasty are heterogeneous, limiting direct comparison. Arthrodesis studies reported return-to-sport rates of up to 100%, with a shift from high-impact to in-line activities. Implant arthroplasty showed similar return-to-sport rates, with potential short-term functional benefits. However, long-term superiority could not be demonstrated, and higher complication rates must be considered.
Conclusion

MTP-1 arthrodesis remains a reliable treatment for end-stage hallux rigidus, offering satisfactory long-term sports function. Implant arthroplasty may provide short-term advantages in active patients but carries a higher risk of complications and has not shown superior long-term outcomes in sports participation.
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NewsBot · Oct 30, 2025

OUTCOMES AFTER FIRST METATARSOPHALANGEAL JOINT FUSION FOLLOWING FAILURE OF CARTIVA HEMIARTHROPLASTY
The Canadian Orthopaedic Association (COA) Annual General Meeting, Calgary, Alberta, Canada, 21–24 June 2023. Part 2 of 2.

S. Bambarawana
M. Glazebrook
J. Morash
A. Walls

Abstract

Arthritis of the great toe metatarsophalangeal joint (MTPJ) remains the commonest arthritic condition of the foot with significant impact on patients lives. Arthrodesis has remained the mainstay of surgical treatment of this condition. However, Polyvinyl Alcohol (PVA) hydrogel arthroplasty of the 1st metatarsophalangeal joint has become a valid and mainstream means of surgical treatment of hallux rigidus. However, the literature outlines concerns regarding the conversion to arthrodesis with other hemiarthroplasty and total 1st MTPJ arthroplasty implants due to the increased complexity of arthrodesis with regards to bone loss and the need for bone grafting. The primary aim of this study is to to determine the outcomes of patients who had subsequent revision surgery to fusion for failure of this implant. Secondarily, we aim to document the medium to long term survivorship of 1st MTPJ Cartiva arthroplasty in a single foot and ankle unit at an academic centre.

We retrospectively reviewed all MTPJ arthroplasty procedures performed by our unit since the commencement of Cartiva hemiarthroplasty in 2009 to June 2021. From a total of 197 identified, 173 cases were included in the study. A full chart review was conducted to determine if conversion to fusion had taken place during follow up. For the subset of patients who went on to an arthrodesis, we calculated the time to revision surgery, fixation method and use of bone graft or graft substitute. The X-rays at last follow up were reviewed to determine whether union has been achieved. The pre Cartiva, pre revision and post revision X-rays were reviewed to measure the length of the 1st metatarsal and ray. Visual analogue scale for pain, Foot and Ankle Ability Measure (FAAM) - sport and activities of living (ADL) sub scales along with short form 36 physical functioning score (SF-36 PFS) were collected to determine functional outcomes.

We noted a 10 year revision free survivorship of 82.3%. Of the 16 patients who underwent revision to fusion, 4 (26.6%) patients developed a non union, all of whom were symptomatic and required revision. All these patients went on to fusion after re-revision. The Cartiva procedure resulted in no significant loss of the metatarsal length with an average loss of height of 0.88 mm. The average SF-36 PCS was 39.5 at latest follow up, with a FAAM ADL score of 77.2, and a FAAM SDL of 59.4. The average VAS pain score following 1st MTPJ fusion for failed Cartiva hemiarthroplasty was 3.3.

Although we noted no significant loss of metatarsal length or complexity of surgery converting a failed Cartiva to fusion, we noted a higher non union rate and worse functional outcomes compared to primary arthrodesis of the 1st MTPJ.

NewsBot · Nov 12, 2025 at 7:23 PM

Is Second Metatarsal Shortening Osteotomy Necessary With Concomitant First Metatarsophalangeal Joint Arthrodesis? A Case-Control Study
Ramez Sakkab et al
Foot Ankle Spec. 2025 Nov 12:19386400251382149.

First metatarsophalangeal joint arthrodesis is a common surgical intervention for end-stage hallux rigidus and valgus. Such cases can be complicated by disruptions in the metatarsal parabola, particularly an elongated second metatarsal. Some experts advocate for a shortening osteotomy of long metatarsals to restore forefoot balance. However, the present investigators question the benefit of second metatarsal shortening procedures when the first metatarsal is effectively lengthened with arthrodesis. Thus, the current study sought to compare first metatarsophalangeal joint arthrodesis with and without second metatarsal shortening osteotomy. After study criteria, 24 patients undergoing first MTPJ arthrodesis with adjacent Weil osteotomy were matched to 48 patients who underwent first MTPJ arthrodesis alone. Patients were matched for age, sex, indication (hallux rigidus or hallux valgus), metatarsal parabola, body-mass index (BMI), laterality, bone supplementation, fixation type (interfragmentary screw and dorsal locking plate), diabetes, tobacco use, and inflammatory arthropathies. No significant demographic differences were found between the groups (P > .1). At the mean follow-up of 25.5 months, the Weil osteotomy group had twice as many reoperations compared with the control group, at a rate of 25 and 6.3%, respectively (P = .053; OR: 4.9; CI: 1.1-21.7). There were 4 nonunions in each group, with nonunion rates of 16% in the Weil osteotomy group versus 8.3% in the arthrodesis-alone group (P = .43; OR: 2.15; CI: 0.49-9.5). Subsecond metatarsal pain was observed in 16.7% of the Weil osteotomy group (n = 4) and 6.3% of the control group (p= 0.23, OR: 2.8; CI: 0.57-13.6). In this first metatarsophalangeal joint arthrodesis series, no benefit was found when an adjacent second metatarsal shortening osteotomy was completed for preoperative metatarsalgia. Further research is needed to determine if such osteotomies benefit patients undergoing first metatarsophalangeal joint arthrodesis.
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Surgery for hallux rigidus

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Joint replacement surgery for hallux rigidus

Hallux Limitus/Rigidus surgery

Gait changes following surgery for hallux rigidus

Long term follow up of hallux rigidus surgery

Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

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Surgery for hallux rigidus

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Joint replacement surgery for hallux rigidus

Hallux Limitus/Rigidus surgery

Gait changes following surgery for hallux rigidus

Long term follow up of hallux rigidus surgery

Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

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