Open vs Percutaneous Moberg Osteotomy With Dorsal Cheilectomy for Hallux Rigidus: A Retrospective Comparative Study of Surgical Approaches With Minimum 2 Years' Follow-up.

BACKGROUND

Hallux rigidus is a degenerative condition affecting the first metatarsophalangeal (MTP) joint, characterized by pain and limited dorsiflexion. In early stages (grades I and II), joint-preserving procedures such as dorsal cheilectomy and Moberg osteotomy are commonly employed. Although traditionally performed through an open approach, the Moberg osteotomy has been adapted to percutaneous techniques, which may offer advantages including reduced soft tissue trauma and faster recovery. This study compares clinical outcomes, postoperative pain, and complication rates between open and percutaneous Moberg osteotomy, both combined with dorsal cheilectomy, in patients with early-stage hallux rigidus.

METHODS

A retrospective analysis was conducted on 96 patients who underwent either open (n = 43) or percutaneous (n = 53) Moberg osteotomy in combination with dorsal cheilectomy. All had failed at least 3 months of nonoperative treatment. Exclusion criteria included prior first-ray surgery and advanced hallux rigidus (grades III and IV). Outcomes included the visual analog scale (VAS), Foot Function Index (FFI), and the number of oxycodone tablets consumed during the first 2 postoperative weeks. Complications and reoperations were also documented.

RESULTS

Both groups showed significant improvements in VAS and FFI scores at a minimum of 24-month follow-up, with no statistically significant differences between them. However, postoperative opioid consumption was significantly lower in the percutaneous group compared with the open group (3.6 ± 1.9 vs 13.3 ± 6.1 tablets over 2 weeks; P < .0001).Wound complications occurred in 4.7% of the open group and 0% of the percutaneous group (P = .20). Reoperation rates were comparable, with 2.3% in the open group and 1.9% in the percutaneous group.

CONCLUSION

Percutaneous Moberg osteotomy with dorsal cheilectomy is a safe and effective treatment for early-stage hallux rigidus, yielding comparable functional and pain outcomes to the open technique, with lower early postoperative opioid use in this cohort.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.