Surgical management for intractable metatarsalgia.

We reviewed the results of arthrodesis of the first metatarsophalangeal joint and excisional arthroplasty of the lesser metatarsophalangeal joints performed on patients who presented intractable metatarsalgia and forefoot deformities. The study included 18 feet (15 patients) in 12 women and 3 men. The follow-up averaged 5.2 years. A good to excellent result was achieved in 15 (83%) feet; pain, which had been moderate to severe before surgery, was reduced to none to mild, and function, which had been severely limited before surgery, was improved to virtually unlimited. The fusion rate of the first metatarsophalangeal joint was 94% (17 of 18 feet). Thirteen of the 15 patients (87%) stated they would have the procedure again. This repair has been demonstrated to be a useful salvage procedure in nonrheumatoid patients with severe metatarsalgia secondary to failed forefoot surgery.