Many of these patients have little motion of the MTP joint preoperatively, and the arthrodesis places the toe in a more functional position. Individuals with a fused MTP joint can maintain a high level of activity and participate in a variety of sports. In 1990, Coughlin reported significant pain relief and improved ambulation after MTP joint arthrodesis. Her activities are limited. A physical exam reveals a plantarflexed great toe which does not allow for comfortable shoe wear.
Radiographs show dorsal osteophytes and joint space narrowing.
In this case, I would recommend the Keller procedure along with removal of any prominent osteophytes. In the more active individual, the results are less predictable due to the possibility of instability and drifting of the great toe. The first ray also may lose its weightbearing function after this procedure with subsequent development of transfer metatarsalgia. There exist many clinical situations that do not ideally fit these three case examples for which the surgeon must counsel the patient regarding the treatment options and come to a decision regarding which would be the most appropriate procedure. Although cheilectomy, arthrodesis and the Keller procedure are the operations which I most commonly utilize in the treatment of hallux rigidus, there are others which deserve mention here.