Metatarsophalangeal arthrodesis of the first toe by distraction and bone interposition for the treatment of severe first ray deficiency

Abstract

The shortening of the first toe and the resulting major bone defect of the first radius is a complication which is observed fairly frequently when the base of the phalanx is over-resected, as occurs in the Keller-Brandes technique, although this may also be presented in other situations and when using other techniques for hallux valgus surgery. Metatarsophalangeal arthrodesis was undertaken in 14 cases, after distraction with an external minifixator to create a space, then implanting a cortical and cancellous autogenous bone graft so that it fitted between the remainder of the phalanx and the metatarsal bone. Surgical stages of the technique undertaken are described. Results were good in 78% of cases. Cases classified as fair or bad were due to vascular complications and postsurgical metatarsal pain. Using this technique it has been possible to confirm the disappearance of pain, the recovery of the length of the first toe, and an improvement in function and in the aesthetic appearance of the foot, which enables the patient to use normal footwear.