Does an adjunct Moberg osteotomy improve outcomes in patients undergoing cheilectomy for hallux rigidus? A systematic review.

BACKGROUND: Hallux rigidus is a progressive degenerative condition of the first metatarsophalangeal joint (MTPJ) treated with joint-preserving procedures such as cheilectomy. Adjunct Moberg osteotomy has been proposed to improve dorsiflexion and reduce dorsal joint impingement. PURPOSE: This systematic review aims to compare clinical outcomes between isolated cheilectomy and cheilectomy with Moberg osteotomy for hallux rigidus. STUDY DESIGN: Systematic review METHODS: This systematic review was conducted according to PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched from inception to 4 May 2026. Studies directly comparing isolated cheilectomy and cheilectomy with Moberg osteotomy for hallux rigidus were included. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). RESULTS: Three retrospective comparative cohort studies comprising 282 patients (284 first MTPJs) were included. Both isolated cheilectomy and cheilectomy with Moberg osteotomy demonstrated significant postoperative improvement in patient-reported outcome measures (PROMs). However, there were no consistent differences in final postoperative PROMs between groups. Complication and revision rates were generally low, with no consistent evidence demonstrating increased complications following adjunct Moberg osteotomy. Considerable heterogeneity existed in operative decision-making algorithms, operative techniques, and rehabilitation protocols. CONCLUSIONS: Both isolated cheilectomy and cheilectomy with Moberg osteotomy produce significant postoperative improvement in hallux rigidus. However, adjunct Moberg osteotomy did not demonstrate consistent superiority with respect to postoperative patient-reported outcomes, complication rates, or reoperation rates. Further prospective comparative studies with standardized operative indications, rehabilitation protocols, and outcome reporting are required to better define the role of adjunct Moberg osteotomy in the management of hallux rigidus.