Return to sport after osteotomy in patients with hallux rigidus

Introduction: Hallux rigidus (HR) is a common degenerative condition of the first metatarsophalangeal joint (MTPJ), particularly limiting in active adults and athletes. While joint-sacrificing procedures such as arthrodesis are effective, joint-preserving techniques remain preferable in patients wishing to maintain function and mobility. The modified Youngswick osteotomy offers such an option by decompressing and realigning the joint. Methods: This retrospective observational study included 55 physically active patients (mean age: 42.8 ± 8.5 anni years) with grade II HR who underwent modified Youngswick osteotomy between 2015 and 2022. Inclusion criteria included active engagement in sports, age under 60 years, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), the European Foot and Ankle Society (EFAS) score, and return to sports (RTS) rates. Results: At a mean follow-up of 79.3 months, 49 of 52 patients (94.2 %) resumed sports activities. Significant improvements were observed in VAS scores (from 5.04 to 0.9, p < .001) and EFAS general (22.7 ± 6.1–37.1 ± 5.4, p < .001) and sport-specific scores (9.3–14.3, p < .001). Postoperative dorsiflexion improved from a mean of 24.5° to 52.5° (p < .001). Complications were rare and mild, including two cases of transfer metatarsalgia and one hardware intolerance. Conclusion: Modified Youngswick osteotomy is an effective joint-preserving surgical option for moderate HR in active adults. It provides excellent pain relief, improves function and range of motion, and allows for a high rate of return to sports. This technique represents a valid alternative to arthrodesis in patients wishing to maintain MTPJ mobility and an active lifestyle.