Minimally invasive cheilectomy with first metatarsal plantarflexory osteotomy fixated via intramedullary plating device - A novel technique for the management of hallux limitus and concomitant metatarsus primus elevatus: A case report with 3-year follow-up and surgical technique guide

Background Hallux Limitus/Rigidus is a well-described pathologic spectrum, although the surgical management, especially when observed with concomitant metatarsus primus elevatus, can present less-than-desirable outcomes. While there is an abundance of available literature on the surgical management of these pathologies, more recent findings potentiate a continued need for a more encompassing approach. Study Design Case Report with Technique Guide. Methods We report the case of a 79-year-old male with painful symptomatic late-stage hallux limitus. Conservative measures were attempted and failed. Upon electing surgical intervention, a minimally invasive cheilectomy and 1 st metatarsal plantarflexory osteotomy was conducted to address the hallux limitus and elevatus components simultaneously. Results The implementation of this novel surgical technique improved clinical factors, allowed for restoration of 1 st metatarsal positioning, satisfactory exposure to address periarticular osteophytosis secondary to hallux limitus, while allowing for a minimal degree of soft tissue dissection. Postoperative course was uneventful with marked improvement in 1 st metatarsophalangeal joint motion and patient's pain and symptom generators, even when compared at 3-year follow-up. No recurrence of the resected exostoses or metatarsal malalignment was noted. Conclusion Recent literature has suggested the need for a more comprehensive approach when surgically addressing hallux limitus with associated metatarsus primus elevatus. The novel technique described in the report today of a minimally invasive cheilectomy coupled with plantarflexory osteotomy fixated via intramedullary plating appears to be a safe and effective surgical option. The advantageous minimal incisional window allowed for increased soft tissue protection without detracting from the correction of the root pathologies intraoperatively. Level of Evidence IV. Case-Report