Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

Abstract

Hallux varus deformity most commonly occurs as a complication of bunion surgery. Surgical option depends on the underlying cause, flexibility of the deformity, and presence of osteoarthritis of the first metatarsophalangeal joint. Joint-preserving surgery including medial soft tissue release, metatarsal osteotomy, and tendon transfer can be considered in flexible deformity without degeneration of the first metatarsophalangeal joint. First metatarsophalangeal arthrodesis is indicated in cases of inflammatory arthritis, avascular necrosis, osteoarthritis, neuromuscular disorder, or failed previous hallux varus corrective surgery. The purpose of this technical note is to describe the technique of arthroscopic arthrodesis of the first metatarsophalangeal joint to correct hallux varus deformity. It has the potential advantages of less surgical trauma, preservation of blood supply, less postoperative pain, and better cosmetic results.

Arthroscopic Release of the First Metatarsophalangeal Joint: The 3-Portal Approach

“…The proximal plantar medial portal is 5- to 10-mm proximal to the plantar proximal margin of the first metatarsal head and between flexor hallux brevis and abductor hallucis tendons ( Fig 1 ). 2 , 8 , 9 , 10 , 11 , 12

Fig 1 Arthroscopic release of the left first metatarsophalangeal joint: the 3-portal approach. The patient is in supine position with the legs spread.

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Metatarsosesamoid Arthroscopy for Management of Plantar Pain of the First Metatarsophalangeal Joint After Surgical Correction of Hallux Valgus Deformity

“…The proximal plantar medial portal is 5 to 10 mm proximal to the plantar proximal margin of the first metatarsal head and between the flexor hallux brevis and abductor hallucis tendons ( Fig 1 ). 5 , 6 , 7 , 8 , 9 , 10

Fig 1 Metatarsosesamoid arthroscopy for management of plantar pain of first metatarsophalangeal joint after surgical correction of left hallux valgus deformity. The patient is in the supine position with the legs spread.

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Arthroscopic Sesamoidectomy and Plantar Metatarsal Head Bone Shaving in Management of First Metatarsal Head Metatarsalgia After First Metatarsophalangeal Fusion

“…The medial portal is at the mid-point of the medial joint line of the first metatarsophalangeal joint and the proximal plantar medial portal is 5 to 10 mm proximal to the plantar proximal margin of the first metatarsal head and between flexor hallux brevis and abductor hallucis tendons ( Fig 2 ). 3 , 4 , 5 , 10 Skin incisions of 3 to 4 mm are made at the portal sites, and the underlying soft tissue is bluntly dissected down to the metatarsosesamoid articulation with a hemostat. The capsule of the metatarsosesamoid articulation is pierced by the tip of the hemostat.…”

“…First metatarsophalangeal arthrodesis (either open or arthroscopic) has been used to treat end-stage arthritis of the great toe (e.g., gout, post-traumatic, infection), severe hallux valgus deformity, hallux valgus caused by neuromuscular disorders, rheumatoid forefoot deformity, primary hallux varus, and rigid plantarflexion deformities, as a salvage procedure for failed previous operation of the great toe including failed previous osteotomies for hallux valgus correction resulting in recurrent deformity, iatrogenic hallux varus or avascular necrosis, as well as salvage after failed resection and replacement arthroplasties or failed cheilectomy. 1 , 2 , 3 , 4 , 5 , 6 This procedure usually results in good clinical outcome. However, complications can occur and include delayed union, nonunion, malunion, wound dehiscence, seroma, infection, osteomyelitis, hallux ischemia, nerve damage, hematoma, failed or prominent and irritating hardware, and hallux interphalangeal joint arthritis.…”