BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

Fusion of the first MTPJ

By Johnny T.C. Lau, MD, FRCSC, Toronto, ON

Originally printed in the COA Bulletin, #66, August/September 2004. Reprinted with kind permission.

Patients with severe hallux valgus with or without inflammatory or degenerative arthritis can be successfully treated with first metatarsophalangeal joint (MTPJ) fusion. Fusion of the first MTPJ reliably corrects deformity, and eliminates pain in cases with arthritis. The success of fusion of the first MTPJ depends on the approach, preparation of bony surfaces, proper alignment, and stable internal fixation.

Indications

Absolute indications for fusion of the first MTPJ are severe hallux valgus associated with degenerative arthritis or rheumatoid arthritis. Severe hallux valgus without arthritis is a relative indication for fusion of the first MTPJ, since a proximal metatarsal osteotomy can correct the deformity and maintain joint motion

Approach

The fusion can be performed through a medial or straight dorsal midline. Both approaches provide adequate exposure of the first MTPJ for fusion, but the medial approach allows for the exposure of the sesamoids in case excision is required. In some patients with metatarsal-sesamoid arthritis, fusion of the first MTPJ alone will not address the pain plantarly, which requires sesamoidectomy.

Preparation of bony surfaces

After first MTPJ exposure, the osteophytes are removed, and the arthritic joint is identified. The arthritic cartilage is removed until subchondral bone is exposed. The surfaces are prepared with flat cuts or a cup-and-cone configuration. Flat cuts can be made with a small oscillating saw, but once the cuts are made, the position of the fusion is fixed unless the cuts are revised. The cup-and-cone configuration is made using a bur or Marin reamers. This bony preparation provides the greatest contact area and allows for easy position of the fusion.

This abstract is a portion of the article which appears in the Spring 2007 issue of BodyCast.  
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