Elliot AD.Borgert AJ.Roukis TS.A prospective comparison of clinic, radiographic, and intraoperative features of hallux rigidus: long-term follow up and analysis. J Foot Ankle Surg55: 547, 2016.10.1053/j.jfas.2016.01.040)| false
Roukis TS.Clinical outcomes after isolated periarticular osteotomies of the first metatarsal for hallux rigidus: a systematic review. J Foot Ankle Surg49: 553, 2010.2103504110.1053/j.jfas.2010.08.014)| false
Roukis TS.Jacobs PM.Dawson DM.et al: A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis. J Foot Ankle Surg41: 158, 2002.
Roukis TS.Jacobs PM.Dawson DM.et al: A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis. J Foot Ankle Surg41: 158, 2002.10.1016/S1067-2516(02)80065-512075903)| false
| 2 Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL.
Hallux limitus (HL) is the second-most common pathology associated with the first metatarsophalangeal joint. A common etiology believed to be associated with HL is metatarsus primus elevatus (MPE), although causation has been unsubstantiated by evidence. Historically, correction of MPE is surgically addressed with an osteotomy. However, some believe MPE is a secondary manifestation of HL due to retrograde pressure and lack of dorsiflexion at the first metatarsophalangeal joint. This study sought to determine whether MPE resolves spontaneously after first metatarsophalangeal joint arthroplasty and reinstitution of normal joint dorsiflexion.
Twenty-seven weightbearing lateral radiographs from patients with HL were reviewed before and after nonimplant first metatarsophalangeal joint arthroplasty. Radiographs were taken preoperatively and at postoperative visits 1 (mean, 2 weeks) and 2 (mean, 10 weeks). Measurements included first to second metatarsal elevation, Seiberg Index, first to fifth metatarsal distance, sagittal plane first to second metatarsal angle, Meary's angle, metatarsal declination angle, and hallux equinus angle.
Statistically significant improvement was seen at both postoperative visits in all of the previously mentioned measurements except first to fifth metatarsal distance, which was reduced but was not statistically significant.
Metatarsus primus elevatus was reduced significantly after first metatarsophalangeal joint arthroplasty. Resolution occurred rapidly and was maintained at the final postoperative visit. This could be due to MPE being a manifestation of HL and not a cause. Based on the results of this study, osteotomies may be unnecessary to surgically address MPE because it can spontaneously correct after reinstitution of first metatarsophalangeal joint motion.
Corresponding author: Patrick J. Sanchez, DPM, Foot and Ankle Institute, 4650 Southwest Hwy, Oak Lawn, IL 60453. (E-mail: email@example.com)