Surgical Options for Hallux Rigidus Based on Etiology: A Review and Commentary

In 1927, Cochrane noted that the elastic resistance in hallux dorsiflexion remained after cheilectomy or dorsiflexion osteotomy of the metatarsal head. This hallux rigidus was attributed to the shortening and tightness of the soft tissues below the first metatarsophalangeal joint. A novel surgery was devised, wherein the plantar tissues were divided through a plantar approach, resulting in favorable outcomes in 12 patients. This revolutionary surgical technique directly addressed the cause of hallux rigidus, but this is not done by the current surgeries. This paper offers a critical review of the current surgeries for hallux rigidus. First, we reviewed the literature on the etiologies of hallux rigidus, dorsal impingement, functional hallux rigidus, hallux primus elevatus, and long metatarsal, then reviewed studies on metatarsal decompression osteotomy, metatarsal dorsiflexion osteotomy, and cheilectomy. Finally, we reviewed the studies on arthroscopic cheilectomy and explored the feasibility of arthroscopic surgery, including the arthroscopic Cochrane procedure, for hallux rigidus.