Meeting NewsPerspective

Cheilectomy yielded low revision, pain recurrence rates in patients with hallux rigidus

CHICAGO — Cheilectomy may be a reliable procedure for treatment of hallux rigidus, with low revision and pain recurrence rates among patients, according to results presented at the American Orthopaedic Foot & Ankle Society Annual Meeting.

Daniel J. Fuchs, MD, and colleagues administered a questionnaire about patient satisfaction with surgery, likelihood to undergo the same surgery again, pain recurrence after surgery, shoe wear limitations and ability to perform various activities to 165 patients who underwent cheilectomy for treatment of symptomatic hallux rigidus. Fuchs noted 18%, 70% and 12% of patients had Coughlin and Shurnas grades 1, 2 and 3, respectively.

“We found that 70% of patients had no pain at final follow-up, with 17% of patients having pain relief and then recurrence, and 13% never improved from surgery,” Fuchs said in his presentation here.

Fuchs noted significant improvement in the VAS pain score from 64 to 11.

“Even in the cohort of patients with residual pain, they had improved VAS scores, which was statistically significant,” Fuchs said.

Postoperatively, nine patients reported an increase of pain and nine patients underwent revision surgery at an average of 3.6 years, according to Fuchs. He also noted 75% of patients reported they would undergo the same surgery again. Female gender and younger age were considered risk factors for recurrence of pain, according to Fuchs.

“In terms of patient’s ability to wear shoes postoperatively, 48% of women could wear a 1-inch or higher heel, 25% a flat dress shoe and 27% a comfortable shoe, whereas 84% of men could wear a dress shoe,” Fuchs said. – by Casey Tingle

Reference:

Sidon E, et al. Long-term follow-up of cheilectomy for treatment of hallux rigidus. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 12-15, 2019; Chicago.

Disclosure: Fuchs reports no relevant financial disclosures.

CHICAGO — Cheilectomy may be a reliable procedure for treatment of hallux rigidus, with low revision and pain recurrence rates among patients, according to results presented at the American Orthopaedic Foot & Ankle Society Annual Meeting.

Daniel J. Fuchs, MD, and colleagues administered a questionnaire about patient satisfaction with surgery, likelihood to undergo the same surgery again, pain recurrence after surgery, shoe wear limitations and ability to perform various activities to 165 patients who underwent cheilectomy for treatment of symptomatic hallux rigidus. Fuchs noted 18%, 70% and 12% of patients had Coughlin and Shurnas grades 1, 2 and 3, respectively.

“We found that 70% of patients had no pain at final follow-up, with 17% of patients having pain relief and then recurrence, and 13% never improved from surgery,” Fuchs said in his presentation here.

Fuchs noted significant improvement in the VAS pain score from 64 to 11.

“Even in the cohort of patients with residual pain, they had improved VAS scores, which was statistically significant,” Fuchs said.

Postoperatively, nine patients reported an increase of pain and nine patients underwent revision surgery at an average of 3.6 years, according to Fuchs. He also noted 75% of patients reported they would undergo the same surgery again. Female gender and younger age were considered risk factors for recurrence of pain, according to Fuchs.

“In terms of patient’s ability to wear shoes postoperatively, 48% of women could wear a 1-inch or higher heel, 25% a flat dress shoe and 27% a comfortable shoe, whereas 84% of men could wear a dress shoe,” Fuchs said. – by Casey Tingle

Reference:

Sidon E, et al. Long-term follow-up of cheilectomy for treatment of hallux rigidus. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 12-15, 2019; Chicago.

Disclosure: Fuchs reports no relevant financial disclosures.

    Perspective

    Hallux rigidus or first metatarsophalangeal (MTP) arthritis is a common condition that has benefitted from a recent increased focus in the literature. Eliezer Sidon, MD, and colleagues show in a large retrospective study of 165 patients, at an average of 6.6 years follow-up, that low- to mid-grade grade hallux rigidus patients (grades 1 to 3) do well with a simple cheilectomy. This finding supports previous work by Mark E. Easley, MD, that came to the same conclusion.

    It is important to note that this paper does not address grade 4 arthritis and no conclusions can be drawn for cheilectomy in very advanced hallux rigidus.

    It is my opinion that a better anatomic classification that outlines where the arthritis is in the MTP (central, peripheral, sesamoids) will evolve to a better classification scheme that is more prognostic and prescriptive of the appropriate treatment options. For now, cheilectomy is the work horse that shows good results in most patients. 

    Reference:

    Easley ME, et al. Foot Ankle Int. 1999;doi:10.1177/107110079902000302.

    • Gregory C. Berlet, MD, FRCS(C), FAOA
    • Orthopedics Today Editorial Board Member
      Section editor, Foot & Ankle

    Disclosures: Berlet reports he is a consultant for Wright Medical Technologies.

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