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Long-term Follow-up of the Green-Watermann Osteotomy for Hallux Limitus

Jason B. Dickerson Submitted during second-year residency, Scripps Mercy Hospital and Medical Center, San Diego, CA, and Kaiser Sacramento, Sacramento, CA; private practice, 5089 S 900 E, Ste 201, Salt Lake City, UT 84117.

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Richard Green Fellow, American College of Foot and Ankle Surgeons; private practice, San Diego, CA.

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Donald R. Green Fellow, American College of Foot and Ankle Surgeons; Residency Director, Scripps Mercy Hospital and Medical Center, San Diego, CA, and Kaiser Sacramento, Sacramento, CA.

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The authors undertook a retrospective analysis of the long-term efficacy of the Green-Watermann procedure for the treatment of painful hallux limitus or rigidus. Questionnaires were sent to 80 consecutive patients who had such procedures performed between 1990 and 1999. Medical records and radiographs were reviewed for the 32 patients who completed the questionnaires, representing 40 Green-Watermann procedures. Twenty-four patients were able to return for clinical evaluation. The average length of follow-up was 4 years (range, 1 to 10 years). The questionnaires addressed pain before and after surgery, function after surgery, complications, and overall impression and satisfaction. Nearly all of the patients (30 of 32; 94%) reported that surgery had significantly relieved their hallux joint pain, and a slightly smaller proportion (28 of 32; 88%) felt that their chief complaints were at least 70% improved. Clinical evaluation revealed adequate range of motion at the first metatarsophalangeal joint. It is concluded that the Green-Watermann procedure is an effective treatment approach for hallux limitus and rigidus, resulting in a significant reduction in pain, an increase in function, and a high degree of patient satisfaction. (J Am Podiatr Med Assoc 92(10): 543-554, 2002)