Abstract
The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.
Highlights
The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus
We report our experience with this procedure as from 2005 up to now all the MTP1 fusions were performed with the above described percutaneous technique
A cupand-cone configuration of bone preparation is more sound than flat bone cuts either for biomechanical reasons and for the arthrodesis positioning that is simpler without first ray shortening [Curtis [10], Goucher [13]
Summary
The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. The main difficulty in this procedure is the 3D positioning of the arthrodesis that should be adapted to global foot anatomy, daily activity and shoe wearing habits of each case [Conti [3], Harper [4], Alexander [5], Kelikian [6], Womack [7] Another non specific difficulty is linked to the primary stability of the fusion depending on both technique for fusion, site preparation and type of internal fixation [Kelikian [6], Womack [7], Chana [8], Wu [9], Curtis [10], Rongstad [11], Watson [12], Goucher [13]. The authors present the technique and results of a percutaneous MTP1 fusion and discuss the benefits and indications
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