Is Second Metatarsal Shortening Osteotomy Necessary With Concomitant First Metatarsophalangeal Joint Arthrodesis? A Case-Control Study.

First metatarsophalangeal joint arthrodesis is a common surgical intervention for end-stage hallux rigidus and valgus. Such cases can be complicated by disruptions in the metatarsal parabola, particularly an elongated second metatarsal. Some experts advocate for a shortening osteotomy of long metatarsals to restore forefoot balance. However, the present investigators question the benefit of second metatarsal shortening procedures when the first metatarsal is effectively lengthened with arthrodesis. Thus, the current study sought to compare first metatarsophalangeal joint arthrodesis with and without second metatarsal shortening osteotomy. After study criteria, 24 patients undergoing first MTPJ arthrodesis with adjacent Weil osteotomy were matched to 48 patients who underwent first MTPJ arthrodesis alone. Patients were matched for age, sex, indication (hallux rigidus or hallux valgus), metatarsal parabola, body-mass index (BMI), laterality, bone supplementation, fixation type (interfragmentary screw and dorsal locking plate), diabetes, tobacco use, and inflammatory arthropathies. No significant demographic differences were found between the groups (P > .1). At the mean follow-up of 25.5 months, the Weil osteotomy group had twice as many reoperations compared with the control group, at a rate of 25 and 6.3%, respectively (P = .053; OR: 4.9; CI: 1.1-21.7). There were 4 nonunions in each group, with nonunion rates of 16% in the Weil osteotomy group versus 8.3% in the arthrodesis-alone group (P = .43; OR: 2.15; CI: 0.49-9.5). Subsecond metatarsal pain was observed in 16.7% of the Weil osteotomy group (n = 4) and 6.3% of the control group (p= 0.23, OR: 2.8; CI: 0.57-13.6). In this first metatarsophalangeal joint arthrodesis series, no benefit was found when an adjacent second metatarsal shortening osteotomy was completed for preoperative metatarsalgia. Further research is needed to determine if such osteotomies benefit patients undergoing first metatarsophalangeal joint arthrodesis.Levels of Evidence: III.