Arthrodesis of the Hallux Metatarsophalangeal Joint.

INTRODUCTION

Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis.

STEP 1 SURGICAL APPROACH: Make a medial approach, following the mid-axis of the joint.

STEP 2 JOINT PREPARATION: Using a cup-cone configuration provides excellent bone exposure, construct stability, and metatarsophalangeal joint congruity.

STEP 3 POSITIONING OF ARTHRODESIS: Fix the toe in 5° to 10° of valgus and elevated 5 mm from the floor to achieve desired dorsiflexion.

STEP 4 APPLICATION OF IMPLANTS: Achieve a stable construct with a crossed lag screw and a dorsal locking plate (a hybrid construct).

STEP 5 CLOSURE: Perform a standard soft-tissue closure.

STEP 6 POSTOPERATIVE CARE: Allow weight-bearing as tolerated after two weeks and impact exercises only after bone healing has been shown on radiographs, which can take up to ten weeks.

RESULTS

Arthrodesis of the metatarsophalangeal joint in the hallux provides good results in terms of patient satisfaction and function, as demonstrated in many studies, most of them retrospective.IndicationsContraindicationsPitfalls & Challenges.