Objective To investigate the effectiveness of basal osteotomy of the first metatarsal combined with first metatarsophalangeal joint replacement for the treatment of hallux valgus combined with hallux rigidus. Methods A retrospective analysis was conducted on the medical records of 15 patients (16 feet) with hallux valgus combined with hallux rigidus who underwent first metatarsal osteotomy combined with first metatarsophalangeal joint replacement between May 2019 and December 2024. The patients included 1 male and 14 females, aged 60-80 years, with an average age of 68.5 years. According to the Mann classification of hallux valgus, 2 feet were moderate and 14 feet were severe. According to the Hallux Rigidus Coughlin grading, 12 feet were grade 3 and 3 feet were grade 4. The evaluation indicators included hallux valgus angle (HVA) and 1-2 inter metatarsal angle (1-2 IMA) measured on weight-bearing X-ray film at preoperation and last follow-up; the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the improvement of walking function, metatarsophalangeal joint function, and pain relief in patients. Results All patients underwent surgery successfully without complications such as vascular or nerve injury during operation. One foot developed a superficial incisional infection postoperatively, which healed after dressing changes; the remaining 15 feet had primary incision healing. All patients were followed up 5-55 months, with an average of 17.5 months. All osteotomies achieved bony union, with a union time ranging from 8 to 13 weeks, averaging 11.8 weeks; no elevation of the first metatarsal was observed. At last follow-up, no complications such as prosthesis loosening, dislocation, fracture, toe shortening, bone dissolution, synovial reaction, or metatarsalgia were found. The appearance and function of the affected feet significantly improved, and the pain significantly relieved. At last follow-up, the HVA, 1-2 IMA, AOFAS score, and VAS score showed significant differences when compared with preoperative values (P<0.05). Conclusion Basal osteotomy of the first metatarsal combined with first metatarsophalangeal joint replacement for the treatment of hallux valgus with hallux rigidus can correct deformities through osteotomy, restore the normal flexion-extension axis of the metatarsophalangeal joint, relieve pain, and preserve a certain degree of mobility, achieving good medium-term effectiveness.
ObjectiveTo investigate the effectiveness of Youngswick-Akin osteotomy in the treatment of moderate hallux valgus combined with mild to moderate hallux rigidus. Methods The clinical data of 43 patients with moderate hallux valgus combined with mild to moderate hallux rigidus who were admitted between August 2019 and August 2022 and met the selection criteria were retrospectively analyzed. There were 8 males and 35 females. The age ranged from 28 to 77 years, with an average age of 59.0 years. The disease duration ranged from 10 to 35 months, with an average of 20 months. The degree of hallux rigidus included 2 cases of Ⅰ degree, 29 cases of Ⅱ degree, 12 cases of Ⅲ degree. The preoperative hallux valgus angle ranged from 25°to 40°, with an average of 32°. All patients were treated with Youngswick-Akin osteotomy. The first metatarsophalangeal joint space was compared before operation and at 6 months after operation. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the functional recovery and pain relief of the patients before operation and at 6 and 24 months after operation. According to the severity of hallux rigidus, the patients were divided into mild group (Ⅰ, Ⅱ degree) and moderate group (Ⅲ degree) to compare the prognosis, including the changes of AOFAS score, VAS score, and the first metatarsophalangeal joint space before and after operation. Results The operation time was 60-75 minutes (mean, 65 minutes). The intraoperative blood loss was 10-30 mL (mean, 20 mL). Two cases had superficial infection of the incision margin after operation, and healed well after incision dressing change and antibiotic treatment. The incisions of the other patients healed by first intention, and no medial cutaneous nerve injury of the great toe occurred. All patients were followed up 24-31 months, with an average of 25.8 months. The patient’s hallux valgus deformity was corrected without recurrence; no complication such as osteomyelitis and hallux varus occurred. The AOFAS score, VAS score, and the first metatarsophalangeal joint space after operation significantly improved when compared with those before operation, the AOFAS score and VAS score at 24 months after operation further improved when compared with those at 6 months after operation, and the differences were significant (P<0.05). The change of VAS score in patients with moderate hallux stiffness was significantly better than that in moderate group (P<0.05); but there was no significant difference in the changes of AOFAS score and the first metatarsophalangeal joint space between the two groups (P>0.05). ConclusionYoungswick-Akin osteotomy for moderate valgus deformity with mild to moderate hallux rigidus can achieve good functional recovery, pain relief, and joint space improvement.