Arthrodesis of the first metatarsophalangeal joint

Arthrodesis of the first metatarsophalangeal joint is the procedure of choice in hallux rigidus with advanced destruction of the joint surfaces. It is also indicated after failed resection arthroplasty in hallux valgus. A dorsal skin incision is used. Flat osteotomy surfaces are created at the first metatarsal head and at the proximal phalanx with a saw. The angle between the great toe and the bottom of the foot should be ten to 15 degrees of dorsal extension. The great toe should be aligned in ten degrees of valgus relative to the first metatarsal bone, and in neutral rotation. Fixation with a dorsal one-third or one-quarter tubular plate and an interfragmentary lag screw is most stable. Interposition of a bone graft may be necessary in cases of undue shortening of the great toe, as in revision surgery following resection arthroplasty. Full weightbearing in a postoperative shoe with a rigid sole is allowed immediately postoperatively. Results with this technique are good and excellent in approximately 80 percent. The incidence of pseudarthroses is between three and 13 percent, depending on the operative technique. Symptomatic degeneration of the interphalangeal joint occurs in approximately 10 percent of patients at long-term follow-up.