Decompressive first metatarsal osteotomy for the treatment of Hallux rigidus: A systematic review.

BACKGROUND

Hallux rigidus causes first metatarsophalangeal joint pain and limitation. Decompressive first metatarsal osteotomy (DCO) aims to improve joint biomechanics and preserve motion whilst avoiding arthrodesis.

METHODS

A PRISMA-compliant systematic review of MEDLINE and Cochrane was conducted, assessing patient-reported outcomes and complications.

RESULTS

Thirty studies (n = 1293 feet) met inclusion criteria (44-month follow-up). Youngswick osteotomy was commonest (33.3%); 76.7% had concomitant cheilectomy performed. Mean improvements: AOFAS 41 points, VAS 5 points, range of motion 26 °. Most studies showed moderate to serious risk of bias.

CONCLUSION

DCO combined with cheilectomy may improve outcomes in selected patients with early/moderate hallux rigidus. The evidence is predominantly low-quality observational data, and concomitant cheilectomy in most studies confounds the independent benefit of the osteotomy, with outcomes comparable to published cheilectomy series. Patient selection is critical, with greatest benefit likely in grade II-III disease and a long / elevated first metatarsal or functional hallux limitus.