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Metatarsophalangeal Joint Arthrodesis for Severe Hallux Valgus in Elderly Patients

March 01, 2017

Contributors: Dario Perugia, MD; Cosma Calderaro, MD; Carolina Civitenga, MD; Andrea Ferretti, MD; Carlo Iorio, MD; Marco Lepri, MD; Vincenzo Masi, MD

Severe hallux valgus is a common condition involving pain and limitation of range of movement to the first metatarsophalangeal (MTP) joint, frequently associated with degenerative arthritis. Conservative treatments have only short-time effectiveness, as activity modification, stiff-soled shoes, orthotics, non-steroidal anti-inflammatory drugs, and cortisone injections. The commonly used surgical correction techniques include proximal osteotomy or distal osteotomy with extreme bone translation that can be associated to other joint sparing procedures as cheilectomy, phalangeal osteotomy, and shortening first metatarsal osteotomy. Despite this, often pain, range of movement limitation, and functional impairment remain. Although there are few studies in the literature, the arthrodesis of the first metatarsophalangeal joint is a reliable procedure to address this conditions, with good to excellent results. Arthrodesis of the first metatarsophalangeal joint can be performed in many different ways and a mean union rate of approximately 90% was reported in the literature. Postoperatively, the patient is allowed to weight bear on their heel in a postoperative shoe, and then allowed to walk flatfooted after radiographic healing (typically four to six weeks). Potential complications include the general surgery risks associated with anesthesia, infection, damage to nerves, and bleeding. Complications specific to MTP fusion include delayed bone healing, mal-union, non-union, stiffness in neighboring joints. Inclusion criteria of our study were hallux valgus angle > 40°, age > 70 years, no previous bunion procedure, minimum follow up of two years, AOFAS score administered before surgery. There was a statistical significant improvement of the mean AOFAS score. Overall patient satisfaction was rated as excellent to good. No foot was rated as fair or poor. No recurrence or complications were recorded. In conclusion, metatarsophalangeal arthrodesis is a reliable and successful procedure to correct severe hallux valgus expecially in elderly patients, with high rate of bone fusion, with low rate of complications, without impaitment of the ambulation, and without need of special postoperative rehabilitation protocol.

Results for "Bony Procedure"

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