Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy

• Main Authors: Kar Teoh Dip, SICOT, FEBOT, FRCS(T&O), Weiteen Tan MBBCh, Kartik Hariharan MD
• Format: Article
• Language: English
• Published: SAGE Publishing 2018-09-01
• Series: Foot & Ankle Orthopaedics
• Online Access: https://doi.org/10.1177/2473011418S00486

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint, usually characterised by a dorsal osteophyte. This typically result in impingement pain and limitation of movement of the first MTP joint. Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus. Minimally invasive forefoot surgery is becoming more popular with advances in technology and it is now possible to perform a minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. We aim to report our clinical outcomes following MIDC. Methods: Eighty-nine patients (98 feet; 44 Right, 36 Left, 9 Bilateral) who had symptomatic hallux rigidis with failed conservative treatment, between 2011 and 2016, were included in this study. The average age was 54 (range: 29 – 71) years old. There were 25 Male and 64 Female in our cohort. They were graded preoperatively by Coughlin and Shurnas Classification (Grade 1, n=30; Grade 2, n=48; Grade 3, n=11). Clinical data were recorded. Pre and postoperative Manchester-Oxford Foot Questionnaire [MOxFQ] scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 50 months (range: 12 - 84). Results: Average VAS score improved from 8.0 (range: 6 – 10) preoperatively to 3 (range: 0 – 10) postoperatively. The mean MOxFQ summary index score decreased from 58.6 (range: 30 – 94) preoperatively to 30.5 (range: 0 – 92) postoperatively. All three MOxFQ domains also improved. Swelling took an average of 5.3 (1 – 12) weeks to settle. There were 2 wound infections and 2 delayed wound healing. Two patients had transient nerve paraesthesia while two (2%) patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) had a reoperation, of which 7 had a first MTP joint fusion for ongoing pain (Coughlin Grade 2, n=6; Grade 3, n=1), 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that minimally invasive dorsal cheilectomy (MIDC) shows significant improvement in patient reported outcome measure with MOxFQ scores. MIDC seems to be a safe technique with minimal complications. There is an associated learning curve as 5% of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 do well with MIDC but 10% of our grade 2 & 3 went onto a fusion.