Can immediate weight bearing be achieved following a first metatarsocuneiform arthrodesis with a locking plantar plate and compression screw? A case series evaluating the early safety results in 72 consecutive patients.

BACKGROUND

The literature for a first metatarsocuneiform joint (MCJ) arthrodesis procedure and an early weight bearing post-operative regime (<2 weeks) has been systematically reviewed [1,2]. The concern regarding an increased risk of non-union with early weight bearing has largely been anecdotal. This is a single surgeon retrospective review assessing the union rates achieved following a Lapidus (1st tarsometatarsal joint) arthrodesis in the treatment of Hallux valgus using an anatomically contoured plantar plate and applying an early weight-bearing regime.

METHODS

A retrospective study of consecutive patients who underwent this surgical technique between June 2019 and January 2025 were reviewed. Patients were evaluated at 8 weeks post operation for weight bearing x rays and returned for final clinical review at 6 months post operation. Clinical outcomes were validated through the Manchester-Oxford Foot Questionnaire (MOXFQ) and patient satisfaction (PSQ10) survey. Union of the arthrodesis and complications were reported.

RESULTS

A total of 72 patients (60 female and 12 male) with a mean age of 60.60 (range 29 - 75) were analysed. The mean MOXFQ score improved across all domains. All three domains demonstrated highly significant post-operative improvement (p < 0.001 for all). Mean reductions were 26.2 points for Walking Standing (95% CI: 18.6-35.0; Cohen's d = 0.93), 25.6 points for Pain (95% CI: 18.7-32.9; Cohen's d = 1.03), and 37.5 points for Social Interaction (Cohen's d = 1.66). Effect sizes ranged from large to very large, indicating clinically meaningful improvements. There were no reported non-unions or plate failures. Fixation removal was required in 1 patient (1.5%). Ninety percent of patients were back to normal supportive footwear by 8 weeks.

CONCLUSION

This study has demonstrated the low complication rates and acceptable safety profile of an immediate weight bearing post-operative regime following a first MCJ arthrodesis procedure with a single locking plantar plate fixation modality. It provides a larger cohort of patients to support the benefits of plantar plate fixation highlighted in other supporting systematic reviews for a first tarsometatarsal joint arthrodesis. [2] LEVEL OF EVIDENCE: IV.