The Distal Metatarsal Dorsal-Wedge Osteotomy Using Bio-Compression Screw for Advanced Hallux Rigidus

Kim, Yong Min; Cho, Byung Ki; Kim, Dong Soo; Choi, Eui Sung; Shon, Hyun Chul; Park, Kyoung Jin; Park, Ji Kang; Choi, Seung Myung

Abstract

PURPOSE
This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus.
MATERIALS AND METHODS
Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of 1st MTP (metatarsophalangeal) joint space and the period to union were measured.
RESULTS
The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of 1st MTP joint had improved significantly from preoperative average 17.5degrees to 44degrees (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of 1st MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014).
CONCLUSION
Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.