Arthrodesis of the First Metatarsophalangeal Joint

Abstract

A series of 41 first toe metatarsophalangeal joint arthrodeses performed in 28 patients was subjectively and objectively evaluated by personal interview, physical examination, and follow-up X-rays. The length of the post-operative follow-up ranged from 5 to 58 months, with an average of 35 months. The overall rate of fusion was 95%. Excellent or good results were obtained in 28 procedures, representing 68% of the study of the patients. Utilizing this procedure in the treatment of severe forefoot deformities, secondary to rheumatoid arthritis, demonstrated that 85% of the patients obtained excellent or good results, and, in the treatment of patients with failed bunion surgery, 53% obtained excellent or good results.

Resection arthroplasty with and without capsular interposition for treatment of severe hallux rigidus

“…For surgical treatment of hallux rigidus many different procedures have been described, including resection arthroplasty [3,13], tendon interposition arthroplasty [1,4], cheilectomy [11,16], osteotomy [19], arthrodesis [2,15] and implant arthroplasty [5]. Resection arthroplasty ('Keller procedure') is a surgical procedure mostly used for older patients suffering from severe osteoarthritis of the first metatarsophalangeal joint.…”

Arthrodesis in the treatment of hallux rigidus

“…Since then various surgical procedures have been published, including osteotomies [2,20], cheilectomy [7,13], resection arthroplasty [18], implant arthroplasty [5,19] and arthrodesis [4,8,10,22,30,31]. Also, various methods of fixation have been described, such as small tubular compression plating [14,22,23,31], external fixation [17], compression screws [6,8,10,22,27], wire sutures [8,9], absorbable sutures [1], Herbert screws [30], Steinmann pins [15], Rush pins [28], Kirschner wires [8,10] and bone staples [21].…”

“…Some authors use flat osteotomies of the articular surfaces because of the simplicity of the technique [15,27], with a reported fusion rate of 90% [4]. Others prefer curved surfaces created by using reamers [4,10,16,29] or a "hole-saw", with a reported fusion rate of 92% [4].…”

The foot

“…In this respect, arthrodesis seems preferable [19,36]. A disadvantage of arthrodesis is the increased risk for interphalangeal joint destruction, either by peroperative trauma of axial pins or later by increased pressure as the foot concludes the stepping motion [2,34]. Several methods have been described for achieving great toe arthrodesis.…”