Return to Sports and Physical Activities after First Metatarsophalangeal Joint Arthrodesis in Young Patients

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Arthrodesis of the first metatarsophalangeal (MTP) joint has been shown to be effective and reliable in alleviating pain and correcting deformity. However, the effect on patient participation in specific sports and physical activities has not been well established. For this reason, younger patients that are more physically active may be less likely to undergo this procedure, despite significant first MTP joint pathology and symptoms. The aim of this study was to assess specific sports and physical activities in young patients following first MTP joint arthrodesis as well as clinical outcomes. Methods: This was a single-center study conducted from a review of a prospectively collected registry. Eligible patients were contacted for final follow up. All cases of first MTP arthrodesis in skeletally mature patients age 55 and under between October 2006 and December 2014 were included. Exclusion criteria included concomitant metatarsal osteotomies, midfoot or hindfoot fusions, and systemic or other musculoskeletal disease that would otherwise impact physical activity participation. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS). Physical activity participation was evaluated with a physical activity and sports-specific, patient-administered questionnaire. Seventy-three eligible patients were identified that met the inclusion and exclusion criteria. Fifty patients (68%) were reached for follow up and were included in this study. The mean age at the time of surgery was 49.7 (23-55) years. Thirty-four percent of patients were male and 66% female. The average follow up was 5.1 (2.2-10.2) years. Results: There was significant improvement in all FAOS subcategories, including pain (49.9-84.1, p<0.001), other symptoms (64.1- 77.8, p<0.001), function in daily activities (67.0-89.0, p<0.001), function in sport and recreation (38.7-68.5, p<0.001) and quality of life (20.7-63.9, p<0.001). There was no difference between male and female patients (p>0.05). Patients reported participation in 14 different sports and physical activities. The most common were walking, cycling, weight lifting, swimming, running and aerobics. Compared to preoperatively, patients rated 26% of activities as less difficult, 54% as the same, and 20% as more difficult. Patients returned to 84% of their activities in < 12 months and 42% in < 6 months, with 61% reaching their peak performance level in < 12 months. Ninety-two percent of patients were satisfied with their outcome. Conclusion: First MTP joint arthrodesis is a reasonable option in young, physically active patients. Improved clinical outcomes and satisfactory pain reduction were achieved in all patients. The majority of patients were able to return to a wide variety of physical activities and sports, and were satisfied with their level attained. A small group of patients that participated in more high impact sports reported increased difficulty post-operatively, however, there was an increased number of patients that reported decreased difficulty in these same activities. This may be beneficial in patient counselling and aid in treatment decision making.