Hallux Rigidus: Proximal Phalangeal Osteotomy/Enclavement Procedure

Abstract

The enclavement joint decompressive osteotomy of the first proximal phalanx can be an effective joint preserving procedure for hallux limitus/rigidus. Regnauld first described it in 1968.1,2 He demonstrated three different variations of the procedure. Effectively, the proximal portion of the first proximal phalanx is shortened. It is believed that the procedure is effective by creating space between the proximal phalanx and the first metatarsal. It is also thought that by releasing the intrinsic muscles from the base of the proximal phalanx this would provide less tension on the joint.3 This is an alternative to other phalangeal procedures such as the “Bonney-Kessel” and “Moeberg” procedures. These procedures, also performed within the first proximal phalanx, address the decreased Hallux dorsiflexion problem by effectively placing the Hallux in a more dorsiflexed position.