Arthrodesis of the first metatarsophalangeal joint.

Loyola University Medical Center, Maywood, Illinois, USA.

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.

PMID: 15239355 [PubMed - indexed for MEDLINE]