A 58-year-old man reports pain over the top of the first metatarsophalangeal joint aggravated by walking uphill and stiff dress shoes. Examination shows a bony prominence dorsally over the first MTP joint with dorsiflexion limited to 15 degrees and painful crepitus. Radiographs show joint space narrowing confined to the superior aspect with a large dorsal osteophyte. After failed shoe modification and NSAIDs, the most appropriate next step is:
- A Cheilectomy with dorsal osteophyte excision ✓
- B First MTP joint arthrodesis at 15 degrees of valgus
- C Distal soft tissue release with proximal metatarsal osteotomy
- D Silicone hemiarthroplasty of the first MTP joint
Correct answer: A. Cheilectomy with dorsal osteophyte excision
Explanation
This is hallux rigidus with dorsal impingement and preserved motion arc, corresponding to early grade disease. Cheilectomy removes the dorsal osteophyte and the dorsal third of the metatarsal head, relieving impingement pain while retaining native cartilage, and is the standard operation for grade 1 and 2 disease. Arthrodesis is reserved for advanced grade 3 disease with global cartilage loss, and silicone implants have high failure rates from synovitis and loosening.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.