Retrospective Analysis of the Reverdin-Green Osteotomy for Hallux Rigidus in the Presence of Metatarsus Primus Elevatus

CATEGORY: Bunion INTRODUCTION/PURPOSE: Hallux rigidus outlines progressive degenerative changes in the 1st metatarsophalangeal joint (MTP I) by several causative factors, i.e. metatarsus primus elevatus. It often leads to disability, difficulties wearing shoes, and gait abnormalities. Despite numerous non-operative and surgical treatments for hallux rigidus reported in the literature, a gold standard treatment protocol for the disease is still missing. Thus, this study investigates the clinical and radiographic outcomes of the commonly used Reverdin-Green Osteotomy (RGO) by validated outcome measurements. METHODS: We retrospectively reviewed medical records of ten patients (12 feet) that were diagnosed with hallux rigidus in the presence of metatarsus primus elevatus (MPE) and underwent RGO procedure. Primary study objective was the clinical outcomes of the RGO procedure, among others measured by validated FFI and SF12 scores. Secondary study objective was to determine any progression of MTP1 arthritis after the procedure. RESULTS: The average 1st MTP dorsiflexion had improved from 39° (SD ± 21°) to 54° (SD ± 17°). The average value of the AOFAS, hallux metatarsophalangeal-interphalangeal subscale was 81 points (±9.5). The FFI, revealed an average score of 27.5 (± 18.7). The VAS-FA was 70.5 (± 19) for pain, 77.7 (± 23) for function. In the SF-12 survey, the general physical health score was 73 (± 19) and the general mental health score 76 (± 14) on average. Only one patient demonstrated a radiological progression of MTP joint degeneration from grade 2 to grade 3. In all other cases, arthritis grading remained stable. A MPE of equal or more than 5 mm was present (mean 6.9, SD ± 1.7) in all feet. CONCLUSION: In the presence of supposedly causative MPE, the RGO seems to be a reasonable option. To determine the most appropriate surgical solution for treatment of specific stages of hallux rigidus, long-term follow-up and further studies are necessary in the future.