Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis Gastón Slullitel a , Valeria López a , Juan P. Calvi a , Riccardo D’Ambrosi b, *, Federico Giuseppe Usuelli c a Institute of Orthopaedics, “Dr. Jaime Slullitel” San Luis 2534, Rosario, Santa Fe, Argentina b IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, Milan, 20161, Italy c Humanitas San Pio X, via Francesco Nava, 31, Milan, 20159, Italy A R T I C L E I N F O Article history: Received 1 September 2019 Received in revised form 20 November 2019 Accepted 26 November 2019 Available online xxx Keywords: Hallux rigidus Decompressive osteotomy Youngswick osteotomy A B S T R A C T Purpose: The purpose of this study was to evaluate the need for first metatarsophalangeal joint (MTPJ) arthrodesis as a measure of the Youngswick osteotomy survival, or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus. Methods: We retrospectively evaluated 61 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes in the long term using first metatarsophalangeal arthrodesis as an end point. The candidates for inclusion underwent clinical and radiographic evaluation, including the Foot and Ankle Outcome Score (FAOS). Results: Mean follow-up time was 54.8 months. All patients had improved their FAOS, with all achieving postoperative scores >75 points at the final follow up (P < 0.05). Although 49 % (P < 0.05) of the patients depicted worsening of the radiological aspect of the MTPJ, over the long time, no patient needed a first MTPJ arthrodesis. Conclusion: Our results show satisfying long-term outcomes with regard to function, pain relief, and patient satisfaction of the Youngswick osteotomy in grade II as well as grade III hallux rigidus that sustained over the follow up period; even in patients followed up for over 13 years. Level of evidence: III. © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. 1. Introduction Hallux rigidus is a condition characterized by painand restriction in the motion of the first metatarsophalangeal joint (MTPJ), especially in dorsiflexion [1–3]. The symptoms commonly associated with degenerative arthritis of the first MTPJ were initially reported by Davies-Colley in 1887, although Cotteril is credited with proposing the term hallux rigidus [4]. The role of metatarsus primus elevatus (MPE) in the pathogenesis of hallux rigidus has been debated since its first description by Lambrinudi in 1938, but a recent study demonstrated how patients with hallux rigidus had more MPE, in particular in patients with grade 3 and 4. The same study hypothesized that with a higher grade of hallux rigidus, the plantar fascia windlass mechanism no longer functions. The hallux plantar plate contracts, thus limiting hallux dorsiflexion and forcing the first metatarsal into MPE as a secondary phenomenon [5]. As surgical treatment of this entity depends on the etiology and severity of the deformity [6–9], operative procedures have been divided into joint preserving techniques (e.g., cheilectomy and phalanx and first metatarsal osteotomies) and joint sacrificing techniques (e.g., arthrodesis, arthroplasty). The ultimate goal of the treatment is to correct the underlying deformity, relieve the pain, and obtain long term functional results [10]. Although it was initially conceived for a long first metatarsal, Youngswick osteotomy showed good results in both harmonic and non-harmonic formulas, at alleviating pain and improving function over the short and intermediate terms [8]. Nevertheless, studies of this joint preserving procedure that assessed the overall results and the further need of a first metatarsal arthrodesis, reflecting the survival of the technique over the long term period, are lacking. After using the Youngswick first metatarsal decompressive osteotomy for over 13 years, we decided to review a retrospective series of patients. The purpose of this study was to evaluate the need for first metatarsophalangeal joint arthrodesis as a measure * Corresponding author. E-mail addresses: gastonslullitel@gmail.com (G. Slullitel), vlastegiano@gmail.com (V. López), juancalvi@gmail.com (J.P. Calvi), riccardo.dambrosi@hotmail.it (R. D’Ambrosi), fusuelli@gmail.com (F.G. Usuelli). https://doi.org/10.1016/j.fas.2019.11.008 1268-7731/© 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. Foot and Ankle Surgery xxx (2019) xxx–xxx G Model FAS 1395 No. of Pages 5 Please cite this article in press as: G. Slullitel, et al., Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis, Foot Ankle Surg (2019), https://doi.org/10.1016/j.fas.2019.11.008 Contents lists available at ScienceDirect Foot and Ankle Surgery journa l home page : www.e lsevier.com/loca te/fas