The goal of this study was to evaluate the place of arthrodesis of the first metatarso-phalangeal joint in surgery of the fore foot.
The authors studied 225 arthrodesis of the first metatarso-phalangeal joint. 195 had a follow up of from two to fifteen years. The indications were: hallux valgus 52.5 per cent, hallux rigidus 20 p. 100, rheumatoid arthritis 12.5 per cent. The procedure used a stable axial fixation with an antero-posterior screw. The preparation of the joint surfaces allowed equalization of the length of the first two toes.
The study found a patient subjective satisfaction rate of 89.6 per cent. There was no pain for 90 per cent of them. Activities returned to normal 80 per cent of patients. There was radiographic evidence of lack of fusion in 25 cases (13 per cent). Only two cases were painful and justified a revision. In 15 per cent of the cases slight pain at the inter phalangeal joint was noted due to excessive joint function.
The best results were obtained with a dorsal flexion angle between twenty and thirty degrees. Restricted dorsal flexion concerning ankle or inter phalangeal joint is a contra-indication of the procedure. Stable fixation is essential but weight bearing on the fore-foot is not allowed for six weeks.
Arthrodesis of the first metatarso-phalangeal joint restores painless satisfying function and normal use of shoes.