First metatarsophalangeal joint arthrodesis reduces first tarsometatarsal joint alignment
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Isolated first metatarsophalangeal joint arthrodesis may reduce radiographic alignment and subluxation of the first tarsometatarsal joint, according to published results.
James Jastifer, MD, and colleagues measured hallux valgus angle, 1-2 intermetatarsal angle, first metatarsal-medial cuneiform angle, medial cuneiform-first metatarsal angle, relative cuneiform slope and distal medial cuneiform angle in 76 patients who underwent first metatarsophalangeal (MTP) arthrodesis for hallux valgus between 2015 and 2019. Researchers recorded measurements preoperatively and postoperatively for all patients.
Results showed a mean improvement of 23.6° in the hallux valgus angle and of 6.2° in the 1-2 intermetatarsal angle. Researchers found significant preoperative and postoperative differences in the first metatarsal-medial cuneiform angle, medial cuneiform-first metatarsal angle and relative cuneiform slope. However, researchers noted no significant differences between preoperative and postoperative measurements of the distal medial cuneiform angle.
“The take-home message of this study is that it reinforces previous evidence that hallux valgus and first [tarsometatarsal] TMT instability can be corrected by a first MTP arthrodesis,” Jastifer told Healio Orthopedics. “This provides some evidence that first TMT instability is a result of the hallux valgus rather than a cause of the hallux valgus.”
Perspective
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Hallux MTP joint fusion significantly improves the hallux valgus angle and the 1 to 2 intermetatarsal angle after surgery. On average, hallux valgus angle improved by 23.6° and intermetatarsal angle improved by 6.2° before vs. after hallux MTP fusion in the current review of 76 patients.
Many people believe that the only way to address bunion deformity with an increased intermetatarsal angle is with a Lapidus procedure. However, while there have been recent advances in the technique, reproducibility and implants for Lapidus surgery, it is still not without complications, such as technical error, malunion, nonunion and under/over-correction. Especially in patients with concurrent hallux valgus and hallux rigidus, I believe that hallux MTP fusion is an excellent surgical option that can provide reliable, reproducible and definitive improvement in pain and deformity through a single incision.
In cases of moderate to severe hallux valgus with increased hallux valgus angle and intermetatarsal angle, a Lapidus requires multiple incisions, distal soft tissue correction and the possible addition of distal osteotomies, such as an Akin. These additional procedures add time, soft tissue dissection and potential increased risk (ie, infection, wound healing) to the overall surgical treatment. It is important to know that both a Lapidus and hallux MTP fusion can improve hallux valgus angle and intermetatarsal angle so that surgeons can utilize either procedure depending on individual patient needs and preferences.
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