Introduction: Indications for arthrodesis of the first metatarsophalangeal
joint (MTP1) are commonly arthrosis (hallux rigidus),
rheumatoid arthritis, failed hallux valgus surgery, severe hallux valgus,
infectious arthritis, fractures and neuroarthropathies. Many reports
focus on technical and radiological issues but few studies emphasize
the functional outcome considering daily activities, sports and
expectation of the patient.
Method: We retrospectively reviewed the patients who underwent
MTP1-arthrodesis from 2002 to 2005 in our institution. Clinical and
radiological results were assessed but we specially focussed on the
functional outcome. Scoring systems used were the SF-12, EQ-5D,
PASI, FFI and AOFAS (10 points given to MTP1 mobility) scales.
Results: 61 of 64 consecutive patients were evaluated. Female to
male ratio was 49:15, mean age at surgery was 67 years, the average
follow up was 29 month. Even if radiological consolidation was
incomplete in 18 patients, all patients had a clinically stable and rigid
arthrodesis. Mean AOFAS score was 87 (24-100) points at follow up.
The FFI was 5.91% (0-66%). Patient satisfaction was excellent in 37
patients (60%), good in 18 (30%), fair in 5(8%) and poor in1 (2%). EQ-
5D was 0.7 (0.4-1).40 patients (66%) estimated their cosmetic result
as excellent, 15 (25%) as good, 4(6%) as fair and 2 (3%)as poor. 10
patients (16%) had no shoe wear limitation , 48 (79%) had to wear
comfortable shoes and 3 (5%) needed orthopaedic wearing.
Professionally 34 patients (56%) had better performances, 18 (26%)
had no change and 9 (18%) had aggravation of their capacities but
this was due to other health reasons. In sports, 16 patients (26%) had
better performances, 35 patients (57%) no change and 10 (17%) were
worse as consequence of other health problems for 7. Finally, 56
patients (92%) would recommend the operation and 5 (8%) would not.
Conclusion: Experience of clinical practice suggests that the idea of
fusing the first MTP joint is initially frequently disregarded by the
patients because they fear to be limited by a rigid forefoot. Our results
show, in fact, that this procedure can be proposed for numerous
pathological situations with the perspective of good to excellent
outcome in terms of function and quality of life in the majority of cases.