Does Sesamoid Pathology Adversely Impact Outcomes of Cheilectomy in the Treatment of Hallux Rigidus?

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Hallux rigidus (HR) is the most common degenerative pathology of the foot, marked by degenerative osteoarthritis of the first metatarsophalangeal joint (MTPJ) and reduced sagittal motion. Cheilectomy remains the standard of treatment, with satisfactory pain relief and increases in MTPJ range of motion (ROM). While the majority of these patients have satisfactory outcomes, a subset remains dissatisfied with persistent pain and poor ROM. In this study, we aim to assess the effect of sesamoid pathology on the functional outcomes of those undergoing cheilectomy for hallux rigidus. METHODS: Electronic medical records were retrospectively reviewed to identify patients who underwent cheilectomy, with or without a corrective osteotomy (Moberg or Akin) for a diagnosis of HR, identified through CPT code 28289. The data referenced was from November 2019 through November 2021, belonging to three fellowship-trained foot and ankle specialists at a single high volume orthopedic practice. Exclusion criteria included revision procedures, loss of follow-up prior to one year, and prior sesamoidectomy. Our assessment included the presence of sesamoid arthritis or degeneration, demographic data, stage of HR according to the Coughlin and Shurnas classification on preoperative plain radiographs, a patient-reported pain scale, postoperative satisfaction, ROM, and return to activity. Patients were followed at 6 weeks, 3 months, 6 months, and 1 year. Complications were recorded. Statistical analysis was performed using Pearson's chi-square analysis and a two-sample t-test with significance set at alpha <0.05. RESULTS: In this retrospective study, 74 patients who underwent cheilectomy for the treatment of hallux rigidus were examined; 1 with grade 0 HR, 7 with grade 1 HR, 51 with grade 2 HR, and 15 with grade 3 HR. There were 33 with radiographic evidence of sesamoid arthritis, 41 without. Those with sesamoid arthritis trended towards having less pain relief over the course of our study (p=0.290) and more restricted postoperative ROM (p=0.385), though neither reached significance. There was no difference in complication rates between the two groups (p=0.661). CONCLUSION: The presence of sesamoid pathology appears to trend towards worse outcomes after cheilectomy for the treatment of hallux rigidus. Patients with sesamoid pathology may go unrecognized and may warrant consideration for modalities of treatment beyond cheilectomy for hallux rigidus for more satisfactory outcomes. This study is limited in its power and would benefit from greater sample sizes and more objective parameters of measurement. Nonetheless, this data allows for recognition of these patients in whom cheilectomy does not result in pain relief with the goal of identifying factors to improve care and provide sufficient treatment.