First metatarsophalangeal joint arthrodesis

Abstract

First metatarsophalangeal (MTP) joint fusion is performed to address debilitating pain or functional impairment as a result of a variety of pathologic conditions. It is routinely performed after nonoperative interventions fail for later-stage hallux rigidus, severe hallux valgus, or varus deformities and degenerative, neuromuscular, or inflammatory conditions that result in advanced degeneration of the first metatarsophalangeal joint. It is also effective as a salvage procedure following failed joint-sparing procedures such as hemiarthroplasty or bunion correction. Many different techniques have been described in the literature which can vary in the approach used, joint preparation method, and fixation construct. Regardless of the technique used, the principles of meticulous cartilage debridement, optimal positioning of the joint, ensuring adequate compression, and optimizing biology should be followed. Complications are relatively rare, with a nonunion rate of approximately 5-10% commonly reported in the literature. If fused successively, most patients describe significant pain relief and improvement in daily function and athletic activity.