Original Research| Volume 49, ISSUE 5, P446-451, September 2010

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Radiographic Outcomes Following Primary Arthrodesis of the First Metatarsophalangeal Joint in Hallux Abductovalgus Deformity


      The purpose of this study was to evaluate the radiographic outcomes of primary metatarsophalangeal joint arthrodesis for hallux abductovalgus deformities. Between January 2004 and March 2009, 56 consecutive patients (58 feet) underwent primary arthrodesis of the metatarsophalangeal joint (MTPJ) for severe hallux abductovalgus deformity and or hallux rigidus. Results were assessed by primary radiographic outcome measurements (hallux valgus and first-second intermetatarsal angle). Overall, the mean hallux valgus (HA) angle improved significantly from 31.9° to 13.4° (P < .01). The mean first-second intermetatarsal (IM) angle correction was also signficantly reduced from 14.0° to 9.7° (P < .01). When separated by deformity group (mild, moderate, and severe), the mean hallux valgus and first-second intermetatarsal angles demonstrated statistically significant correction in all groups when comparing preoperative and postoperative values (P < .01). Primary arthrodesis provides predictable radiographic outcomes and effective correction for patients with differing severity of hallux abductovalgus deformity and arthritis of the first metatarsophalangeal joint. A separate proximal osteotomy for severe metatarsus primus varus correction may not be necessary because of the correction achieved at the metatarsophalangeal joint arthrodesis level. The results of this study demonstrate that as the severity of the preoperative deformity increases, the amount of postoperative radiographic (HA and IM angle measurement) correction after MTPJ arthrodesis will improve correspondingly.

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        • Lombardi C.M.
        • Silhanek A.D.
        • Connolly F.G.
        • Dennis L.N.
        • Keslonsky A.J.
        First metatarsophalangeal arthrodesis for treatment of hallux rigidus: a retrospective study.
        J Foot Ankle Surg. 2001; 40: 137-143
        • Yu G.V.
        • Gorby P.O.
        First metatarsophalangeal joint arthrodesis.
        Clin Podiatr Med Surg. 2004; 21: 65-96
        • Mann R.A.
        • Thompson F.M.
        Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis.
        J Bone Joint Surg Am. 1984; 66: 687-692
        • Wu K.K.
        First metatarsophalangeal fusion in the salvage of failed hallux abducto valgus operations.
        J Foot Ankle Surg. 1994; 33: 383-395
        • McKeever D.C.
        Arthrodesis of the first metatarsophalangeal joint for hallux valgus, hallux rigidus, and metatarsus primus varus.
        J Bone Joint Surg Am. 1952; 34-A: 129-134
        • Dayton P.
        • Lopiccolo J.
        • Kiley J.
        Reduction of the intermetatarsal angle after first metatarsophalangeal joint arthrodesis in patients with moderate and severe metatarsus primus adductus.
        J Foot Ankle Surg. 2002; 41: 316-319
        • Pydah S.K.
        • Toh E.
        • Sirikonda S.
        • Walker C.
        Intermetatarsal angular change following fusion of the first metatarsophalangeal joint.
        Foot Ankle Int. 2009; 30: 415-418
        • Mann R.A.
        • Katcherian D.A.
        Relationship of metatarsophalangeal joint fusion on the intermetatarsal angle.
        Foot Ankle. 1989; 10: 8-11
        • Cronin J.J.
        • Limbers J.P.
        • Kutty S.
        • Stephens M.M.
        Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus.
        Foot Ankle Int. 2006; 27: 104-109
        • Tourne Y.
        • Saragaglia D.
        • Zattara A.
        • Maire J.P.
        • Picard F.
        • Montbarbon E.
        • Charbel A.
        Hallux valgus in the elderly: metatarsophalangeal arthrodesis of the first ray.
        Foot Ankle Int. 1997; 18: 195-198
        • Coughlin M.J.
        • Grebing B.R.
        • Jones C.P.
        Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results.
        Foot Ankle Int. 2005; 26: 783-792
        • Coughlin M.J.
        Hallux valgus.
        J Bone Joint Surg Am. 1996; 78: 932-966
        • Politi J.
        • John H.
        • Njus G.
        • Bennett G.L.
        • Kay D.B.
        First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability.
        Foot Ankle Int. 2003; 24: 332-337
        • Coughlin M.J.
        • Saltzman C.L.
        • Nunley 2nd, J.A.
        Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements.
        Foot Ankle Int. 2002; 23: 68-74
        • Coughlin M.J.
        • Shurnas P.S.
        Hallux rigidus. Grading and long-term results of operative treatment.
        J Bone Joint Surg Am. 2003; 85-A: 2072-2088
        • Coughlin M.J.
        • Mann R.A.
        • Saltzman C.L.
        Surgery of the Foot and Ankle.
        ed 8. Mosby, Philadelphia, PA2006
        • Goucher N.R.
        • Coughlin M.J.
        Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study.
        Foot Ankle Int. 2006; 27: 869-876
        • Humbert J.L.
        • Bourbonnière C.
        • Laurin C.A.
        Metatarsophalangeal fusion for hallux valgus: indications and effect on the first metatarsal ray.
        Can Med Assoc J. 1979; 120: 937-941
        • Stein H.C.
        Hallux valgus.
        Surg Gynecol Obstet. 1938; 66: 889-898
        • Camasta C.A.
        • Pontious J.
        • Boyd R.B.
        Quantifying magnification in pedal radiographs.
        J Am Podiatr Med Assoc. 1991; 81: 545-548
        • Bryant A.
        • Tinley P.
        • Singer K.
        A comparison of radiographic measurements in normal, hallux valgus, and hallux limitus feet.
        J Foot Ankle Surg. 2000; 39: 39-43
        • Condon F.
        • Kaliszer M.
        • Conhyea D.
        • O'Donnell T.
        • Shaju A.
        • Masterson E.
        The first intermetatarsal angle in hallux valgus: an analysis of measurement reliability and the error involved.
        Foot Ankle Int. 2002; 23: 717-721
        • Venning P.
        Sources of error in the production and measurement of standard radiographs of the foot.
        Br J Radiol. 1951; 24: 18-26
        • Fuhrmann R.A.
        [Advances in orthopaedic foot surgery. 9th Annual Congress of the German Association for Orthopaedic Foot Surgery, Jena, 14–15.03.2003].
        Orthopade. 2003; 32: 659-666