A 48-year-old man presents with pain over the dorsum of the first metatarsophalangeal joint, worse with walking uphill and wearing shoes. There is a bony prominence dorsally with restricted and painful terminal dorsiflexion of the great toe. Radiographs show a large dorsal osteophyte on the first metatarsal head with preserved joint space. The most appropriate initial surgical procedure if conservative measures fail is:
- A Keller resection arthroplasty
- B Cheilectomy ✓
- C First MTP joint fusion
- D Scarf osteotomy
Correct answer: B. Cheilectomy
Explanation
This is hallux rigidus with grade 1 to 2 changes: dorsal osteophyte, painful dorsiflexion, and reasonably preserved joint space. Cheilectomy, excision of the dorsal osteophyte along with about a third of the dorsal metatarsal head, relieves impingement and preserves the joint. Fusion is reserved for advanced arthritis with severe joint space loss, and Keller arthroplasty is avoided in active patients because it causes push-off weakness. A scarf osteotomy treats hallux valgus, not rigidus.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.