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Surgical Management of Hallux Rigidus

Hallux rigidus is the most common degenerative joint pathology of the foot. Untreated, it may result in notable limitations in gait, activity level, and daily function. Positive outcomes can be achieved with nonsurgical management; surgery is recommended for the sufficiently symptomatic patient for whom nonsurgical measures are unsuccessful. Surgery is selected based on grade of involvement. Early to mid-stage hallux rigidus is best managed with cheilectomy or cheilectomy and proximal phalanx osteotomy. Arthrodesis and arthroplasty are reserved for late-stage hallux rigidus.

Proximal Oblique Sliding Closing-wedge Osteotomy for Wide-angle Hallux Valgus

Proximal metatarsal osteotomies are generally recommended for treating severe hallux valgus deformities. The most common complications after surgery for such deformities are recurrence, hallux varus, or dorsal malunion. To decrease these complications, modifications have been made in the design, technique, and fixation procedure for this corrective surgery. In this article, we describe the proximal metatarsal osteotomy procedure known as the proximal oblique sliding closing-wedge (POSCOW) osteotomy, which was developed to include a proximal lateral displacement and a lateral closing-wedge osteotomy, thereby combining the effects of rotation and displacement of the hallux following preoperative planning. Plate fixation has been used in this procedure to improve fixation and decrease malunion. We report in detail the preoperative considerations, surgical technique, results, and complications of the POSCOW procedure.