Arthrodesis of the first metatarsophalangeal joint.

ABSTRACT

Arthrodesis has emerged as the primary salvage procedure for severe osteoarthritis of the first metatarsophalangeal (MTP) joint. Forty-three patients underwent arthrodesis of the first MTP joint with stabilization provided by either 2 crossed lag-screws or a dorsal plate and screws. First MTP joint arthrodesis was the primary procedure for 46 of the 54 treated feet. Joint surfaces were shaped into a ball-and-socket configuration to augment joint surface contact and facilitate alignment for arthrodesis. Postoperative care involved using a compressive bandage, a surgical shoe, and a cane, crutches, or a walker. Partial weight-bearing was allowed immediately after surgery. Few casts were used postoperatively. At a mean of 21.7 months (median, 13.5 months), 34 of the 43 patients completed a brief telephone survey about surgical outcomes. Radiographic measurements of intermetatarsal, hallux valgus, inclination, and dorsiflexion angles were made preoperatively and postoperatively. Mean time to fusion was 7.3 weeks; arthrodesis was successful for 50 of 52 feet (radiographs were missing for 2 of the 54 feet treated). Internal fixation devices were removed from 5 feet. Thirty (88.2%) of the 34 patients rated their result as excellent or good; the other 4 (11.8%) rated their result as poor.