Skip to main content

Advertisement

SpringerLink
Log in

Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Percutaneous metatarsophalangeal arthrodesis is an option for the treatment of hallux rigidus in more advanced cases. The aim of this study was to investigate the clinical and radiographic results at least 2 years after percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus.

Methods

This is a case series of consecutive patients undergoing percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus grades III and IV with a minimum of 24 months of clinical and radiographic follow-up. The primary outcome was clinical assessment using the Visual Analog Scale for Pain (VAS). Secondary outcomes included American Orthopedic Foot & Ankle Society (AOFAS) score, patient satisfaction, complications, and bone healing (radiographic analysis).

Results

Between August 2017 and February 2020, 29 feet (24 patients) underwent percutaneous metatarsophalangeal arthrodesis. The mean follow-up was 38.4 (range 24–54) months. There was an improvement in the pain (VAS) from 7.8 to 0.6 (p < 0.001) and in the AOFAS score from 49.9 to 83.6 (p < 0.001). There was a rate of bone union of 82.8% and screw removal of 13.8%. All patients considered the result to be excellent or good.

Conclusion

The treatment of grade III and IV hallux rigidus with percutaneous metatarsophalangeal arthrodesis demonstrated high patient satisfaction and significantly improves in clinical outcomes but the nonunion rate was higher than reported outcomes for open 1st metatarsophalangeal joint arthrodesis.

Level of evidence

IV, case series.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

Not available.

References

  1. Ho B, Baumhauer J (2017) Hallux rigidus EFORT. Open Rev 2:13–20. https://doi.org/10.1302/2058-5241.2.160031

    Article  Google Scholar 

  2. Lam A, Chan JJ, Surace MF, Vulcano E (2017) Hallux rigidus: how do I approach it? World J Orthop 8:364–371. https://doi.org/10.5312/wjo.v8.i5.364

    Article  PubMed  PubMed Central  Google Scholar 

  3. Coughlin MJ, Shurnas PS (2003) Hallux rigidus. grading and long-term results of operative treatment. J Bone Jt Surg Am 85:2072–2088

    Article  Google Scholar 

  4. Nicolosi N, Hehemann C, Connors J, Boike A (2015) Long-term follow-up of the cheilectomy for degenerative joint disease of the first metatarsophalangeal joint. J Foot Ankle Surg 54:1010–1020. https://doi.org/10.1053/j.jfas.2014.12.035

    Article  PubMed  Google Scholar 

  5. Walter R, Perera A (2015) Open, arthroscopic, and percutaneous cheilectomy for hallux rigidus. Foot Ankle Clin 20:421–431. https://doi.org/10.1016/j.fcl.2015.04.005

    Article  PubMed  Google Scholar 

  6. Waizy H, Czardybon MA, Stukenborg-Colsman C, Wingenfeld C, Wellmann M, Windhagen H, Frank D (2010) Mid- and long-term results of the joint preserving therapy of hallux rigidus. Arch Orthop Trauma Surg 130:165–170. https://doi.org/10.1007/s00402-009-0857-1

    Article  PubMed  Google Scholar 

  7. Freeman BL, Hardy MA (2011) Multiplanar phalangeal and metatarsal osteotomies for hallux rigidus. Clin Podiatr Med Surg 28:329–344. https://doi.org/10.1016/j.cpm.2011.03.002. (viii)

    Article  PubMed  Google Scholar 

  8. Kilmartin TE (2005) Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients. J Foot Ankle Surg 44:2–12. https://doi.org/10.1053/j.jfas.2004.11.013

    Article  PubMed  Google Scholar 

  9. Politi J, John H, Njus G, Bennett GL, Kay DB (2003) First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability. Foot Ankle Int 24:332–337. https://doi.org/10.1177/107110070302400405

    Article  PubMed  Google Scholar 

  10. Fanous RN, Ridgers S, Sott AH (2014) Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg 20:170–173. https://doi.org/10.1016/j.fas.2014.03.004

    Article  PubMed  Google Scholar 

  11. Bauer T (2017) Percutaneous First Metatarsophalangeal Joint Fusion. Open Orthop J 11:724–731. https://doi.org/10.2174/1874325001711010724

    Article  PubMed  PubMed Central  Google Scholar 

  12. Coutts A, Kilmartin TE, Ellis MJ (2012) The long-term patient focused outcomes of the Keller’s arthroplasty for the treatment of hallux rigidus. Foot (Edinb) 22:167–171. https://doi.org/10.1016/j.foot.2012.02.008

    Article  PubMed  Google Scholar 

  13. Johnson MD, Brage ME (2016) Total toe replacement in the United States: what is known and what is on the horizon. Foot Ankle Clin 21:249–266. https://doi.org/10.1016/j.fcl.2016.01.004

    Article  PubMed  Google Scholar 

  14. McNeil DS, Baumhauer JF, Glazebrook MA (2013) Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int 34:15–32. https://doi.org/10.1177/1071100712460220

    Article  PubMed  Google Scholar 

  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296. https://doi.org/10.1371/journal.pmed.0040296

    Article  Google Scholar 

  16. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  17. Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15(Suppl 1):S17-24. https://doi.org/10.1007/s00586-005-1044-x

    Article  PubMed  Google Scholar 

  18. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353. https://doi.org/10.1177/107110079401500701

    Article  CAS  PubMed  Google Scholar 

  19. Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J, Academic Network for Conservational Hip Outcomes Research G (2012) Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 470:2220–2226. https://doi.org/10.1007/s11999-012-2343-2

    Article  PubMed  PubMed Central  Google Scholar 

  20. Coughlin MJ (1991) Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle 11:195–203. https://doi.org/10.1177/107110079101100402

    Article  CAS  PubMed  Google Scholar 

  21. Dijkman BG, Sprague S, Schemitsch EH, Bhandari M (2010) When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma 24(Suppl 1):S76-80. https://doi.org/10.1097/BOT.0b013e3181ca3f97

    Article  PubMed  Google Scholar 

  22. Corrales LA, Morshed S, Bhandari M, Miclau T 3rd (2008) Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Jt Surg Am 90:1862–1868. https://doi.org/10.2106/JBJS.G.01580

    Article  Google Scholar 

  23. RC T (2020) R: a language and environment for statistical computing. R Found, Vienna

  24. Brodsky JW, Baum BS, Pollo FE, Mehta H (2007) Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus. Foot Ankle Int 28:162–165. https://doi.org/10.3113/FAI.2007.0162

    Article  PubMed  Google Scholar 

  25. Aas M, Johnsen TM, Finsen V (2008) Arthrodesis of the first metatarsophalangeal joint for hallux rigidus–optimal position of fusion. Foot (Edinb) 18:131–135. https://doi.org/10.1016/j.foot.2008.03.002

    Article  PubMed  Google Scholar 

  26. Barca F (1997) Tendon arthroplasty of the first metatarsophalangeal joint in hallux rigidus: preliminary communication. Foot Ankle Int 18:222–228. https://doi.org/10.1177/107110079701800407

    Article  CAS  PubMed  Google Scholar 

  27. Faraj AA, Naraen A, Twigg P (2007) A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model. Foot Ankle Int 28:89–91. https://doi.org/10.3113/FAI.2007.0016

    Article  PubMed  Google Scholar 

  28. Molloy S, Burkhart BG, Jasper LE, Solan MC, Campbell JT, Belkoff SM (2003) Biomechanical comparison of two fixation methods for first metatarsophalangeal joint arthrodesis. Foot Ankle Int 24:169–171. https://doi.org/10.1177/107110070302400212

    Article  PubMed  Google Scholar 

  29. Giacomini P, Fraioli R, Calabro AM, Di Filippo F, Natali PG (1991) Class I major histocompatibility complex enhancement by recombinant leukocyte interferon in the peripheral blood mononuclear cells and plasma of melanoma patients. Cancer Res 51:652–656

    CAS  PubMed  Google Scholar 

  30. Besse JL, Chouteau J, Laptoiu D (2010) Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers and osteosynthesis with pure titanium staples radiological evaluation of a continuous series of 54 cases. Foot Ankle Surg 16:32–37. https://doi.org/10.1016/j.fas.2009.03.008

    Article  PubMed  Google Scholar 

  31. Coughlin MJ (1990) Arthrodesis of the first metatarsophalangeal joint. Orthop Rev 19:177–186

    CAS  PubMed  Google Scholar 

  32. Berlet GC, Hyer CF, Glover JP (2008) A retrospective review of immediate weightbearing after first metatarsophalangeal joint arthrodesis. Foot Ankle Spec 1:24–28. https://doi.org/10.1177/1938640007311920

    Article  PubMed  Google Scholar 

  33. Carro LP, Vallina BB (1999) Arthroscopic-assisted first metatarsophalangeal joint arthrodesis. Arthroscopy 15:215–217. https://doi.org/10.1053/ar.1999.v15.0150211

    Article  CAS  PubMed  Google Scholar 

  34. Carlucci S, Parise AC, Santini-Araujo MG, Conti LA, Villena DS, Dozo CM, Carrasco NM, Sotelano P (2020) Minimally-invasive hallux arthrodesis with endomedullary and a crossed screw fixation. Foot Ankle Surg 26:744–749. https://doi.org/10.1016/j.fas.2019.09.005

    Article  PubMed  Google Scholar 

  35. Bauer T, Lortat-Jacob A, Hardy P (2010) First metatarsophalangeal joint percutaneous arthrodesis. Orthop Traumatol Surg Res 96:567–573. https://doi.org/10.1016/j.otsr.2010.01.011

    Article  CAS  PubMed  Google Scholar 

  36. Carro LP, Golano P, Escajadillo NF, Vallejo MR, de Diego V, Biazzio A (2013) Hallux rigidus: arthroscopic-assisted first metatarsophalangeal joint arthrodesis. Tech Foot Ankle Surg 12:215–219. https://doi.org/10.1097/BTF.0b013e3182a0bbc3

    Article  Google Scholar 

  37. Sott AH (2016) Minimally invasive arthrodesis of 1st metatarsophalangeal joint for hallux rigidus. Foot Ankle Clin 21:567–576. https://doi.org/10.1016/j.fcl.2016.04.009

    Article  CAS  PubMed  Google Scholar 

  38. Ferreira GF, Borges VQ, Moraes LVM, Stefani KC (2021) Percutaneous chevron/akin (PECA) versus open scarf/Akin (SA) osteotomy treatment for hallux valgus: a systematic review and meta-analysis. PLoS ONE 16:e0242496. https://doi.org/10.1371/journal.pone.0242496

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Lee M, Walsh J, Smith MM, Ling J, Wines A, Lam P (2017) Hallux valgus correction comparing percutaneous chevron/akin (PECA) and open scarf/akin osteotomies. Foot Ankle Int 38:838–846. https://doi.org/10.1177/1071100717704941

    Article  PubMed  Google Scholar 

  40. Lai MC, Rikhraj IS, Woo YL, Yeo W, Ng YCS, Koo K (2018) Clinical and radiological outcomes comparing percutaneous chevron-akin osteotomies vs open scarf-akin osteotomies for hallux valgus. Foot Ankle Int 39:311–317. https://doi.org/10.1177/1071100717745282

    Article  PubMed  Google Scholar 

  41. França G, Nunes J, Pinho P, Freitas D, Andrade R, Espregueira-Mendes Jo, Pereira B, Oliva XM (2020) Is arthrodesis still the best treatment option for first metatarsophalangeal joint arthritis?—a systematic review of arthrodesis and arthroplasty outcomes. Ann Jt 6

  42. Hodel S, Viehofer A, Wirth S (2020) Minimally invasive arthrodesis of the first metatarsophalangeal joint: a systematic literature review. Foot Ankle Surg 26:601–606. https://doi.org/10.1016/j.fas.2019.09.001

    Article  PubMed  Google Scholar 

  43. Ferreira GF, Dos Santos TF, Oksman D, Pereira Filho MV (2020) Percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette correction. Foot Ankle Int 41:811–817. https://doi.org/10.1177/1071100720917906

    Article  PubMed  Google Scholar 

  44. Roukis TS (2011) Nonunion after arthrodesis of the first metatarsal-phalangeal joint: a systematic review. J Foot Ankle Surg 50:710–713. https://doi.org/10.1053/j.jfas.2011.06.012

    Article  PubMed  Google Scholar 

  45. Kang YS, Bridgen A (2022) First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques. J Foot Ankle Res 15:30. https://doi.org/10.1186/s13047-022-00540-9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil

    Gabriel Ferraz Ferreira, João Paulo Pedroso & Miguel Viana Pereira Filho

  2. Board Members of Minimally Invasive Foot Ankle Society (MIFAS), Merignac, France

    Jorge Javier Del Vecchio

  3. Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Thomas Lorchan Lewis

  4. Department of Orthopaedics, Rheumatology and Traumatology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil

    Mauro Cesar Mattos e Dinato

  5. Hospital Municipal Ouro Verde, Campinas, Brazil

    Vitor Baltazar Nogueira

  6. Member of Minimally Invasive Foot Ankle Society (MIFAS), Merignac, France

    Gabriel Ferraz Ferreira & Gustavo Araujo Nunes

  7. Instituto Vita, São Paulo, Brazil

    Gabriel Ferraz Ferreira, Mauro Cesar Mattos e Dinato & Miguel Viana Pereira Filho

Authors
  1. Gabriel Ferraz Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. João Paulo Pedroso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gustavo Araujo Nunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jorge Javier Del Vecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Lorchan Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauro Cesar Mattos e Dinato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vitor Baltazar Nogueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miguel Viana Pereira Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed equally to this study.

Corresponding author

Correspondence to Miguel Viana Pereira Filho.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Ethical approval

This study was approved by the Research Ethics Committee (Plataforma Brasil CAAE number 50500721.3.0000.8114).

Consent to participate

All patients included in the study have given written consent to participate.

Consent to publish

All patients included in the study have given written consent to have their personal data published.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1Video 1. Percutaneous Metatarsophalangeal Arthrodesis technique (Video) (MP4 48652 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferreira, G.F., Pedroso, J.P., Nunes, G.A. et al. Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years. Arch Orthop Trauma Surg 143, 6521–6526 (2023). https://doi.org/10.1007/s00402-023-04948-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04948-1

Keywords

Search

Navigation