Skip to main content
SpringerLink
Log in

First Metatarsophalangeal Joint Arthrodesis

  • Chapter
  • First Online:
Foot and Ankle Fusions

Abstract

First metatarsophalangeal (MTP) joint fusion is performed to address debilitating pain or functional impairment as a result of a variety of pathologic conditions. It is routinely performed after nonoperative interventions fail for later-stage hallux rigidus, severe hallux valgus, or varus deformities and degenerative, neuromuscular, or inflammatory conditions that result in advanced degeneration of the first metatarsophalangeal joint. It is also effective as a salvage procedure following failed joint-sparing procedures such as hemiarthroplasty or bunion correction. Many different techniques have been described in the literature which can vary in the approach used, joint preparation method, and fixation construct. Regardless of the technique used, the principles of meticulous cartilage debridement, optimal positioning of the joint, ensuring adequate compression, and optimizing biology should be followed. Complications are relatively rare, with a nonunion rate of approximately 5–10% commonly reported in the literature. If fused successively, most patients describe significant pain relief and improvement in daily function and athletic activity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Clutton H. The treatment of hallux valgus. St Thomas Hosp Rep. 1894;22:1–12.

    Google Scholar 

  2. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85-A(11):2072–88.

    Article  PubMed  Google Scholar 

  3. Brodsky JW, Passmore RN, Pollo FE, Shabat S. Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int. 2005;26(2):140–6.

    Article  PubMed  Google Scholar 

  4. Doty J, Coughlin M, Hirose C, Kemp T. Hallux metatarsophalangeal joint arthrodesis with a hybrid locking plate and a plantar neutralization screw: a prospective study. Foot Ankle Int. 2013;34(11):1535–40.

    Article  PubMed  Google Scholar 

  5. Ellington JK, Jones CP, Cohen BE, Davis WH, Nickisch F, Anderson RB. Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int. 2010;31(5):385–90.

    Article  PubMed  Google Scholar 

  6. Goucher NR, Coughlin MJ. Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int. 2006;27(11):869–76.

    Article  PubMed  Google Scholar 

  7. Kumar S, Pradhan R, Rosenfeld PF. First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int. 2010;31(9):797–801.

    Article  PubMed  Google Scholar 

  8. Wassink S, van den Oever M. Arthrodesis of the first metatarsophalangeal joint using a single screw: retrospective analysis of 109 feet. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2009;48(6):653–61.

    Google Scholar 

  9. Hyer CF, Scott RT, Swiatek M. A retrospective comparison of first metatarsophalangeal joint arthrodesis using a locked plate and compression screw technique. Foot Ankle Spec. 2012;5(5):289–92.

    Article  PubMed  Google Scholar 

  10. Coughlin MJ, Grebing BR, Jones CP. Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results. Foot Ankle Int. 2005;26(10):783–92.

    Article  PubMed  Google Scholar 

  11. Fitzgerald J. A review of the long-term results of arthrodesis of the first metatarso-phalangeal joint. J Bone Joint Surg Br. 1969;51:488–93.

    CAS  PubMed  Google Scholar 

  12. DeSandis B, Pino A, Levine DS, Roberts M, Deland J, O’Malley M, et al. Functional outcomes following first metatarsophalangeal arthrodesis. Foot Ankle Int. 2016;37(7):715–21.

    Article  PubMed  Google Scholar 

  13. DeFrino PF, Brodsky JW, Pollo FE, Crenshaw SJ, Beischer AD. First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int. 2002;23(6):496–502.

    Article  PubMed  Google Scholar 

  14. van Doeselaar DJ, Heesterbeek PJC, Louwerens JWK, Swierstra BA. Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int. 2010;31(8):670–5.

    Article  PubMed  Google Scholar 

  15. Giza E, Sullivan M, Ocel D, Lundeen G, Mitchell M, Frizzell L. First metatarsophalangeal hemiarthroplasty for hallux rigidus. Int Orthop. 2010;34(8):1193–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kline AJ, Hasselman CT. Metatarsal head resurfacing for advanced hallux rigidus. Foot Ankle Int. 2013;34(5):716–25.

    Article  PubMed  Google Scholar 

  17. Raikin SM, Ahmad J, Pour AE, Abidi N. Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am. 2007;89(9):1979–85.

    PubMed  Google Scholar 

  18. Erkocak OF, Senaran H, Altan E, Aydin BK, Acar MA. Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus. Foot Ankle Int. 2013;34(11):1569–79.

    Article  PubMed  Google Scholar 

  19. Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total arthroplasty of the metatarsophalangeal joint of the hallux. Foot Ankle Int. 2016;37(7):755–65.

    Article  PubMed  Google Scholar 

  20. Gibson JNA, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int. 2005;26(9):680–90.

    Article  PubMed  Google Scholar 

  21. Baumhauer JF, Singh D, Glazebrook M, Blundell C, De Vries G, Le ILD, et al. Prospective, randomized, multi-centered clinical trial assessing safety and efficacy of a synthetic cartilage implant versus first metatarsophalangeal arthrodesis in advanced hallux rigidus. Foot Ankle Int. 2016;37(5):457–69.

    Article  PubMed  Google Scholar 

  22. Roukis TS. Nonunion after arthrodesis of the first metatarsal-phalangeal joint: a systematic review. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2011;50(6):710–3.

    Google Scholar 

  23. Grimes JS, Coughlin MJ. First metatarsophalangeal joint arthrodesis as a treatment for failed hallux valgus surgery. Foot Ankle Int. 2006;27(11):887–93.

    Article  PubMed  Google Scholar 

  24. Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am. 2000;82(3):322–41.

    Article  CAS  PubMed  Google Scholar 

  25. Stevens BW, Anderson JG, Bohay DR. Hallux metatarsophalangeal joint fusion for the rheumatoid forefoot. Foot Ankle Clin. 2007;12(3):395–404, v.

    Article  PubMed  Google Scholar 

  26. Mulcahy D, Daniels TR, Lau JT-C, Boyle E, Bogoch E. Rheumatoid forefoot deformity: a comparison study of 2 functional methods of reconstruction. J Rheumatol. 2003;30(7):1440–50.

    PubMed  Google Scholar 

  27. Rosenbaum D, Timte B, Schmiegel A, Miehlke RK, Hilker A. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int. 2011;32(6):589–94.

    Article  PubMed  Google Scholar 

  28. Brodsky JW, Ptaszek AJ, Morris SG. Salvage first MTP arthrodesis utilizing ICBG: clinical evaluation and outcome. Foot Ankle Int. 2000;21(4):290–6.

    Article  CAS  PubMed  Google Scholar 

  29. Garras DN, Durinka JB, Bercik M, Miller AG, Raikin SM. Conversion arthrodesis for failed first metatarsophalangeal joint hemiarthroplasty. Foot Ankle Int. 2013;34(9):1227–32.

    Article  PubMed  Google Scholar 

  30. Gross CE, Hsu AR, Lin J, Holmes GB, Lee S. Revision MTP arthrodesis for failed MTP arthroplasty. Foot Ankle Spec. 2013;6(6):471–8.

    Article  PubMed  Google Scholar 

  31. Rammelt S, Panzner I, Mittlmeier T. Metatarsophalangeal joint fusion: why and how? Foot Ankle Clin. 2015;20(3):465–77.

    Article  PubMed  Google Scholar 

  32. Fuhrmann RA. First metatarsophalangeal arthrodesis for hallux rigidus. Foot Ankle Clin. 2011;16(1):1–12.

    Article  PubMed  Google Scholar 

  33. Vertullo CJ, Nunley JA. Participation in sports after arthrodesis of the foot or ankle. Foot Ankle Int. 2002;23(7):625–8.

    Article  PubMed  Google Scholar 

  34. Humbert JL, Bourbonnière C, Laurin CA. Metatarsophalangeal fusion for hallux valgus: indications and effect on the first metatarsal ray. Can Med Assoc J. 1979;120(8):937–41, 956.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Cronin JJ, Limbers JP, Kutty S, Stephens MM. Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus. Foot Ankle Int. 2006;27(2):104–9.

    Article  PubMed  Google Scholar 

  36. Pydah SKV, Toh EM, Sirikonda SP, Walker CR. Intermetatarsal angular change following fusion of the first metatarsophalangeal joint. Foot Ankle Int. 2009;30(5):415–8.

    Article  PubMed  Google Scholar 

  37. McKean RM, Bergin PF, Watson G, Mehta SK, Tarquinio TA. Radiographic evaluation of intermetatarsal angle correction following first MTP joint arthrodesis for severe hallux valgus. Foot Ankle Int. 2016;37(11):1183–6.

    Article  PubMed  Google Scholar 

  38. Singh B, Draeger R, Del Gaizo DJ, Parekh SG. Changes in length of the first ray with two different first MTP fusion techniques: a cadaveric study. Foot Ankle Int. 2008;29(7):722–5.

    Article  PubMed  Google Scholar 

  39. Harper MC. Positioning of the hallux for first metatarsophalangeal joint arthrodesis. Foot Ankle Int. 1997;18(12):827.

    Article  CAS  PubMed  Google Scholar 

  40. Myerson MS, Schon LC, McGuigan FX, Oznur A. Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length. Foot Ankle Int. 2000;21(4):297–306.

    Article  CAS  PubMed  Google Scholar 

  41. Luk PC, Johnson JE, McCormick JJ, Klein SE. First metatarsophalangeal joint arthrodesis technique with interposition allograft bone block. Foot Ankle Int. 2015;36(8):936–43.

    Article  PubMed  Google Scholar 

  42. Bhosale A, Munoruth A, Blundell C, Flowers MJ, Jones S, Davies MB. Complex primary arthrodesis of the first metatarsophalangeal joint after bone loss. Foot Ankle Int. 2011;32(10):968–72.

    Article  PubMed  Google Scholar 

  43. Curtis MJ, Myerson M, Jinnah RH, Cox QG, Alexander I. Arthrodesis of the first metatarsophalangeal joint: a biomechanical study of internal fixation techniques. Foot Ankle. 1993;14(7):395–9.

    Article  CAS  PubMed  Google Scholar 

  44. Coughlin MJ, Abdo RV. Arthrodesis of the first metatarsophalangeal joint with Vitallium plate fixation. Foot Ankle Int. 1994;15(1):18–28.

    Article  CAS  PubMed  Google Scholar 

  45. Bennett GL, Sabetta J. First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation. Foot Ankle Int. 2009;30(8):752–7.

    Article  PubMed  Google Scholar 

  46. Alshouli MT, Lin A, Kadakia AR. Simultaneous first metatarsophalangeal joint arthrodesis and sesamoidectomy with a single dorsomedial incision. Foot Ankle Spec. 2014;7(5):403–8.

    Article  PubMed  Google Scholar 

  47. Brodsky JW, Baum BS, Pollo FE, Mehta H. Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus. Foot Ankle Int. 2007;28(2):162–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Justin Tsai

  2. Jefferson Medical College, Philadelphia, PA, USA

    Steven M. Raikin

  3. Foot and Ankle Service, Orthopedic Foot and Ankle Fellowship Program, Rothman Institute, Philadelphia, PA, USA

    Steven M. Raikin

Authors
  1. Justin Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven M. Raikin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven M. Raikin .

Editor information

Editors and Affiliations

  1. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Christopher P. Chiodo

  2. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Jeremy T. Smith

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Tsai, J., Raikin, S.M. (2018). First Metatarsophalangeal Joint Arthrodesis. In: Chiodo, C., Smith, J. (eds) Foot and Ankle Fusions. Springer, Cham. https://doi.org/10.1007/978-3-319-43017-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43017-1_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43016-4

  • Online ISBN: 978-3-319-43017-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation