Let's return to the conversation.

Okay, so I'm going to present this paper that was done by my mentors, Dr. O'Malley and Dr. Deland on treatment of advanced stages of hallux rigidus with chilectomy and phalangeal osteotomy, otherwise known as a Moberg osteotomy.

And so what they did was they took patients, about 80 patients who had end-stage hallux rigidus.

So there's this classification, there's multiple classifications of hallux rigidus.

There's the, the Coughlin one, which was a radiographic one and a clinical one.

This.

Classification is I think the Johnson one, and it's classified grade one through three, just on radiographs.

With the training that maybe younger foot and ankle surgeons are getting or people doing very specific foot and ankle MIS specific fellowships, maybe, you know, as long as you have the right patient with the right indication, Do you need to necessarily do an open Young's wick to do an MIS Young's wick and, you know, give the patient the same benefits?

Matt, what's your experience?

Yeah, I mean, I love the Hallux MP fusion.

I think it's a very reliable procedure, and so in, in my practice, if patients are on the fence, I probably lean towards a Hallux MP fusion because I also have had the experience where I've done a cheilectomy or a cheilectomy proximal phalanx osteotomy that we'll talk about, and patients have come back unhappy, or I get the follow-up.

I just had one of our, like, Broadway performers write to me, and he's like, [laughs] "I'm a little bit better than I was, but I'm not great." And we knew that going into it, and so, you know, I always feel that sometimes I know I'm pushing the limits of the cheilectomy Moberg sometimes, but I just feel that the reliability of the Hallux MP fusion is so good that it's sometimes hard to take a chance with something else.

And if you're an older patient, not even that old, I mean, we have a study, the institution HSS has a study that Scott Ellis did a while back and looked at patients under the age of 50 and their activity level after a Hallux MP fusion, and they were able to get back to basically everything, with the exception of yoga, and then we all know, and wearing heels.

So there are some things that are challenging, but I just feel from a reliability standpoint, I don't have a lot of Hallux MP fusions who, after they're fused and they're, and they're fused in the right position, that come back and are upset about it even years later, but I have had the cheilectomy, like a cheilectomy or a joint-saving procedure come back and say, you know, "I'm better, I'm not happy, and no one's given me a hug, and I like hugs." So I would much rather, I'd much rather do the fusion if I'm on the fence, but, you know, it's always a conversat- just like everything we do, it's always a conversation, and some people need that, that joint motion.

Anyone who's doing this? Sarah? Matt?

So yeah.