CORR Insights®: Validation of the Artificial Floor Technique in First Metatarsophalangeal Joint Arthrodesis

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

“…The chief problem tends to be sagittal alignment because it is difficult to find a reference point for sagittal alignment of the first metatarsophalangeal joint. 6 It is also technically difficult to produce a true lateral view of the first metatarsophalangeal joint and accurately measure the fusion sagittal angle on intraoperative fluoroscopy because of the overlapping lesser metatarsals and digits. 6 , 15 In case of the significant dorsiflexion malunion of the fusion site with excessive plantar pressure of the first metatarsophalangeal joint and abutment of the hallux to the shoebox, corrective osteotomy is indicated.…”

“… 6 It is also technically difficult to produce a true lateral view of the first metatarsophalangeal joint and accurately measure the fusion sagittal angle on intraoperative fluoroscopy because of the overlapping lesser metatarsals and digits. 6 , 15 In case of the significant dorsiflexion malunion of the fusion site with excessive plantar pressure of the first metatarsophalangeal joint and abutment of the hallux to the shoebox, corrective osteotomy is indicated. If there is isolated excessive plantar pressure of the first metatarsophalangeal joint without hallux problem, arthroscopic sesamoidectomy and bone shaving of the plantar side of the first metatarsal head is another surgical option.…”

“…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.…”

“… 2 , 7 , 8 , 9 Excessive plantar pressure can occur under the first metatarsal head, and, most of the time, it is due to excessive dorsiflexion resulting in increased plantar pressure at the first metatarsophalangeal joint, compensatory interphalangeal joint hyperflexion, and dorsal impingement of the great toe against the shoe wear. 2 , 6 This is typically treated by corrective osteotomy if conservative treatment fails to relieve symptoms. 9 In case of excessive plantar pressure at the fused first metatarsophalangeal joint with relatively normal sagittal alignment of the great toe, sesamoidectomy is an alternative surgical option.…”