No Progression to MTPJ Arthrodesis with Youngswick Osteotomy for Hallux Rigidus Stage II and III

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Hallux rigidus treatment by the means of decompressive osteotomy would theoretically be able to alleviate pain and improve function. The Youngswick osteotomy is a procedure conceived for relatively long first metatarsals, a characteristic that has been associated with the pathogenesis of hallux rigidus. Nevertheless, studies of this procedure that assessed the overall results and further need of a first metatarsal arthrodesis over the years are lacking. After using the Youngswick first metatarsal decompressive osteotomy for many years, we decided to review a retrospective series of patients. The purpose of this study was to evaluate the need for first metatarsophalangeal joint arthrodesis or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus. METHODS: A retrospective review of 61 consecutive patients (61 feet) who had undergone decompressive osteotomy by the same surgical team during a period of 156 months was performed. The candidates for inclusion into the present study underwent a clinical evaluation preoperatively, and the clinical data recorded in the patients’ medical records were reviewed retrospectively. All clinical measurements were taken at the initial preoperative examination and at the final follow-up visit. Patients underwent Youngswick first metatarsal osteotomy as described in previous publication. The clinical examination included the the Foot and Ankle Outcome Score (FAOS), total range of motion of the first MTPJ. Radiographic examinations (AP and lateral weightbearing) were performed preoperatively, immediately postoperatively, and at each patient’s last follow-up visit by another member who was unaware of the clinical results. The need of any secondary procedure of the first metatarsal or subsequent need of first MTPJ arthrodesis was also recorded. RESULTS: Decompressive osteotomy was performed in 61 patients, including 41 right feet and 20 left feet, with no bilateral procedures. The patient population consisted of 45 females (78%), with an average age of 53.8 years (range 29 to 72) years. The mean follow-up time was 54.8 months (range 12 to 150). 74% (45 patients) were classified as grade II and 16 patients (26%) as grade III. All patients who underwent this procedure had improvement their visual analog scale foot and ankle score, with all achieving postoperative scores >75 points. Evaluation at the last follow-up visit showed that 91% of patients would recommend the same procedure to a family member. In our group of patients there were no further needs of first MTPJ arthrodesis. CONCLUSION: We found significant visual analog scale foot and ankle score, providing evidence that good outcomes and high levels of patient satisfaction can be achieved, and that this results would maintain over time. Secondary procedures mainly hardware removal were somewhat usual, however no first MTPJ arthrodesis was needed in the medium term.