This 19-year single-surgeon case series evaluated cheilectomy and first MTP arthrodesis in 110 patients with hallux rigidus. It simultaneously validated a new five-grade clinical-radiographic classification system to guide surgical selection. Mean follow-up was 9.6 years after cheilectomy and 6.7 years after arthrodesis.
The single most important decision in hallux rigidus surgery is distinguishing Grade 3 from Grade 4 — and that distinction is entirely clinical, not radiographic. Grades 3 and 4 look identical on X-ray. The only difference is mid-range passive motion pain on exam. When you find it, plan for arthrodesis.
For Grade-3 cases where you proceed with cheilectomy, the operative report must document your cartilage estimate. If intraoperative inspection reveals less than 50% metatarsal head cartilage remaining, convert to arthrodesis regardless of preoperative plan. This threshold predicts failure with statistical confidence (p = 0.002).
When counseling patients about worsening postoperative radiographs, this paper is your reference: joint space loss after cheilectomy carries no correlation with functional outcome (r = 0.08, p = 0.34). Treat the patient, not the X-ray.
One technical benchmark to confirm before closing: at least 70° of intraoperative dorsiflexion after 25-33% dorsal metatarsal head resection. If you cannot reach this with adequate resection, reassess your procedure choice.
This 19-year single-surgeon case series evaluated cheilectomy and first MTP arthrodesis in 110 patients with hallux rigidus. It simultaneously validated a new five-grade clinical-radiographic classification system to guide surgical selection. Mean follow-up was 9.6 years after cheilectomy and 6.7 years after arthrodesis.
The single most important decision in hallux rigidus surgery is distinguishing Grade 3 from Grade 4 — and that distinction is entirely clinical, not radiographic. Grades 3 and 4 look identical on X-ray. The only difference is mid-range passive motion pain on exam. When you find it, plan for arthrodesis.
For Grade-3 cases where you proceed with cheilectomy, the operative report must document your cartilage estimate. If intraoperative inspection reveals less than 50% metatarsal head cartilage remaining, convert to arthrodesis regardless of preoperative plan. This threshold predicts failure with statistical confidence (p = 0.002).
When counseling patients about worsening postoperative radiographs, this paper is your reference: joint space loss after cheilectomy carries no correlation with functional outcome (r = 0.08, p = 0.34). Treat the patient, not the X-ray.
One technical benchmark to confirm before closing: at least 70° of intraoperative dorsiflexion after 25-33% dorsal metatarsal head resection. If you cannot reach this with adequate resection, reassess your procedure choice.