Hallux Rigidus: Distal First Metatarsal Osteotomy/Hohmann Procedure

Abstract

Treatment of hallux rigidus with distal first metatarsal osteotomy has been advocated for many years.1-7 In clinical situations when there is a significantly long and elevated first metatarsal, along with dorsal hyperostosis, decreased hallux dorsiflexion, and pain, a surgical solution is to shorten and plantarflex the first metatarsal. This can be achieved by many techniques. These include distal, mid, and proximal first metatarsal osteotomies, Lapidus-type procedures and Cotton (dorsal opening-wedge) osteotomy of the first cuneiform.1,4 The results of these types of procedures are currently evidence Level IV. Randomized study of various procedures including comparing osteotomy for hallux rigidus to other techniques, such as arthrodesis, has not been performed. The results of reasonably sized case series in the short and medium term appear promising; there is only one study with more than 10 years average postsurgery follow-up.