Decompressive osteotomy of the first metatarsal with capsular interposition as treatment for hallux rigidus. Case report

Abstract

Hallux rigidus is a progressive degeneration of the first metatarsophalangeal joint that causes pain, decreased mobility, and the development of osteophytes. It is the second most common cause of pain in this joint after hallux valgus. Several etiologies have been proposed, with traumatic origin being the most frequently cited in the literature. Surgical treatment options have ranged from simple cheilectomy, with or without osteotomy of the proximal phalanx, osteotomy of the distal metatarsal, total or partial arthroplasty with implants, or interposition arthroplasty, to arthrodesis. General objective: determine the clinical, radiological, and functional evolution of a young patient with hallux rigidus after surgical treatment with decompressive distal osteotomy of the first metatarsal plus capsular interposition arthroplasty. Clinical case: 34-year-old female patient with pain and functional limitation of the first metatarsophalangeal joint of 6 months' duration. Results: in the immediate postoperative period, the passive dorsiflexion range of the first metatarsophalangeal joint doubled, and the following results were obtained at 8 weeks postoperative follow-up: the preoperative Foot Function Index was 31% and the postoperative score was 12%; the preoperative score on the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Rating System (AOFAS-HMI) was 64% and the postoperative score was 85%. Conclusion: the combined technique, which includes Weil osteotomy of the first metatarsal plus soft tissue interposition arthroplasty, is a reliable long-term treatment for hallux rigidus and is a safe and effective alternative in young, active patients. Functional results are optimal, and the risk of complications is low.