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What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus?

      ABSTRACT

      First metatarsalphalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a triplane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 97% able to walk without restrictions and or pain, 98% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.

      Level of Clinical Evidence

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      References

        • Farzadi M
        • Sanjari MA
        • Jalali M
        • Saeedi H
        • Kamali M
        • Movahedi Yeganeh M
        Ground reaction force complexity in Hallux Valgus.
        Clin Biomech. 2021; 81105229
        • LaPorta GA
        • Nasser EM
        • Mulhern JL
        • Malay DS.
        The mechanical axis of the first ray: a radiographic assessment in Hallux Abducto Valgus evaluation.
        J Foot Ankle Surg. 2016; 55: 28-34
        • Naguib S
        • Derner B
        • Meyr AJ.
        Evaluation of the mechanical axis of the first Ray before and after first metatarsal-phalangeal joint reconstructive surgery.
        J Foot Ankle Surg. 2018; 57: 1140-1142
        • Da Cunha RJ
        • MacMahon A
        • Jones MT
        • Savenkov A
        • Deland J
        • Roberts M
        • Levine D
        • Elliot A
        • Kennedy J
        • Drakos M
        • Ellis SJ
        Return to sports and physical activities after first metatarsophalangeal joint arthrodesis in young patients.
        Foot Ankle Int. 2019; 40: 745-752
        • Donegan RJ
        • Blume PA.
        Functional results and patient satisfaction of first metatarsophalangeal joint arthrodesis using dual crossed screw fixation.
        J Foot Ankle Surg. 2017; 56: 291-297
        • Kuik L
        • Chmiel J
        • Jaskólski D
        • Łuczkiewicz P.
        Mid-term functional results and failure analysis after first metatarsophalangeal joint arthrodesis.
        Ortop Traumatol Rehabil. 2020; 22: 45-53
        • Poggio D
        • de Retana P F
        • Borda D
        • Hortua P
        • Asuncion J
        • Rios J
        Analysis of the clinical score progressions during the first year after first MTPJ fusion.
        Foot Ankle Int. 2010; 31: 578-583
        • Doeselaar DJ van
        • Heesterbeek PJC
        • Louwerens JWK
        • Swierstra BA
        Foot function after fusion of the first metatarsophalangeal joint.
        Foot Ankle Int. 2010; 31: 670-675
        • Gibson JN
        • Thomson CE.
        Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial.
        Foot Ankle Int. 2005; 26: 680-690
        • Kim PJ
        • Hatch D
        • Didomenico L A
        • Lee MS
        • Kaczander B
        • Count G
        • Kravette M.
        A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus.
        J Foot Ankle Surg. 2012; 51: 50-56
        • DeFrino PF
        • Brodsky JW
        • Pollo FE
        • Crenshaw SJ
        • Beischer AD.
        First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study.
        Foot Ankle Int. 2002; 23: 496-502
        • Pinney SJ
        • Song KR
        • Chou LB.
        Surgical treatment of severe Hallux Valgus: the state of practice among academic foot and ankle surgeons.
        Foot Ankle Int. 2006; 27: 1024-1029
        • Dayton P
        • Feilmeier M
        • Hunziker B
        • Nielsen T
        • Reimer RA.
        Reduction of the intermetatarsal angle after first metatarsal phalangeal joint arthrodesis: a systematic review.
        J Foot Ankle Surg. 2014; 53: 620-623
        • DeCarbo WT
        • Dayton P
        • Smith WB
        • McAleer JP
        • Hatch DJ
        • Ray JJ
        • Santrock RD
        Triplanar correction for first metatarsophalangeal fusion.
        J Foot Ankle Surg. 2021; 60: 1044-1047
        • Brodsky JW
        • Baum BS
        • Pollo FE
        • Mehta H.
        Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus.
        Foot Ankle Int. 2007; 28: 162-165
        • Manchanda K
        • Chang A
        • Wallace B
        • Ahn J
        • Xi Y
        • Liu GT
        • Raspovic K
        • Van Pelt M
        • Chhabra A
        • Wukich D
        • Lalli T.
        Short term radiographic and patient outcomes of a biplanar plating system for triplanar Hallux Valgus correction.
        J Foot Ankle Surg. 2021; 60 (2021): 461-465
        • Bock P
        • Kristen KH
        • Kröner A
        • Engel A.
        Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint.
        J Bone Joint Surg Br. 2004; 86: 669-673
        • Senga Y
        • Nishimura A
        • Ito N
        • Kitaura Y
        • Sudo A.
        Prevalence of and risk factors for hallux rigidus: a cross-sectional study in Japan.
        BMC Musculoskelet Disord. 2021; 22: 786
        • Coughlin MJ.
        Arthrodesis of the first metatarsophalangeal joint with mini-fragment plate fixation.
        Orthopedics. 1990; 13: 1037-1044
        • Feilmeier M
        • Dayton P
        • Kauwe M
        • Cifaldi A
        • Roberts B
        • Johnk H
        • Reimer R.
        Comparison of transverse and coronal plane stability at the first tarsal-metatarsal joint with multiple screw orientations.
        Foot Ankle Spec. 2017; 10: 104-108
        • Pydah SKV
        • Toh EM
        • Sirikonda SP
        • Walker CR.
        Intermetatarsal angular change following fusion of the first metatarsophalangeal joint.
        Foot Ankle Int. 2009; 30: 415-418
        • Sung W
        • Kluesner AJ
        • Irrgang J
        • Burns P
        • Wukich DK.
        Radiographic outcomes following primary arthrodesis of the first metatarsophalangeal joint in hallux abductovalgus deformity.
        J Foot Ankle Surg. 2010; 49: 446-451
        • DeSandis B
        • Pino A
        • Levine DS
        • Roberts M
        • Deland J
        • O'Malley M
        • Elliott A.
        Functional outcomes following first metatarsophalangeal arthrodesis.
        Foot Ankle Int. 2016; 37: 715-721
        • Doeselaar DJ van
        • Heesterbeek PJC
        • Louwerens JWK
        • Swierstra BA
        Foot function after fusion of the first metatarsophalangeal joint.
        Foot Ankle Int. 2010; 31: 670-675
        • Bass EJ
        • Sirikonda SP.
        First metatarsophalangeal joint fusion: a comparison of non-union and gender differences between locking and non-locking plating systems.
        Foot (Edinb). 2015; 25: 195-199
        • Besse JL
        • Chouteau J
        • Laptoiu D.
        Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers and osteosynthesis with pure titanium staples Radiological evaluation of a continuous series of 54 cases.
        Foot Ankle Surg. 2010; 16: 32-37
        • Dalat F
        • Cottalorda F
        • Fessy MH
        • Besse JL.
        Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates.
        Orthop Traumatol Surg Res. 2015; 101: 709-714
        • Roukis TS
        • Meusnier T
        • Augoyard M.
        Nonunion rate of first metatarsal-phalangeal joint arthrodesis for end-stage hallux rigidus with crossed titanium flexible intramedullary nails and dorsal static staple with immediate weight-bearing.
        J Foot Ankle Surg. 2012; 51: 308-311
        • Dayton P
        • Santrock R
        • Kauwe M
        • Gansen G
        • Harper S
        • Cifaldi A
        • Egdorf R
        • Eisenschink J.
        Progression of healing on serial radiographs following first ray arthrodesis in the foot using a biplanar plating technique without compression.
        J Foot Ankle Surg. 2019; 58: 427-433
        • Fazal MA
        • Wong JH-M
        • Rahman L.
        First metatarsophalangeal joint arthrodesis with two orthogonal two hole plates.
        Acta Orthop Traumatol Turc. 2018; 52: 363-366
        • Roukis TS.
        Nonunion after arthrodesis of the first metatarsal-phalangeal joint: a systematic review.
        J Foot Ankle Surg. 2011; 50 (c): 710-713