Foot & Ankle International - July 2016 - (Page 715)

642286 FAIXXX10.1177/1071100716642286Foot & Ankle InternationalDeSandis et al research-article2016 Article Functional Outcomes Following First Metatarsophalangeal Arthrodesis Foot & Ankle International® 2016, Vol. 37(7) 715-721 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716642286 fai.sagepub.com Bridget DeSandis, BA1, Alejandro Pino, MD2, David S. Levine, MD1, Matthew Roberts, MD1, Jonathan Deland, MD1, Martin O'Malley, MD1, and Andrew Elliott, MD1 Abstract Background: First metatarsophalangeal (MTP) joint arthrodesis is a common procedure for treatment of arthritis of the first MTP joint. The primary aim of this study was to evaluate the functional outcomes of a series of patients of multiple surgeons undergoing first MTP joint arthrodesis, emphasizing the functional gains with respect to daily activity that can be expected after this procedure. Methods: A retrospective review of 53 patients who underwent successful isolated first MTP joint arthrodesis with either a plate and screw or independent screw construct was performed at our institution over a 6-year period. Successful fusion was defined as no lucency at the first MTP joint and bridging of 2 or more cortices on the anteroposterior, lateral, and oblique radiographic views at final follow-up. Demographic information and radiographs were evaluated for all patients. Preoperative and postoperative Foot and Ankle Outcome Score (FAOS) and Short Form Health Status Survey (SF) 36/12 functional outcome scores, as well as responses from an activity- and footwear-specific questionnaire, were evaluated and compared between the 2 fixation methods. Fifty-three patients (56 feet) had radiographs showing successful fusions after being treated for advanced degenerative arthritis of the first MTP joint with arthrodesis. Average time to union was 5.4 months. Results: There was a significant reduction in difficulty in performing daily activities, with all subscales of the FAOS and the SF-12v2 significantly improving postoperatively (P < .05). The majority of patients stated that their foot looked and felt better and were satisfied with the procedure. Five patients experienced painful hardware, which required removal. Conclusion: First MTP joint arthrodesis was successful in improving patient-reported outcomes, particularly the ability to perform daily activities. Most patients had little to no functional limitation and were satisfied with their outcome. The greatest functional improvements were seen in patients' ability to walk distances and perform low-impact sport activity. Level of Evidence: Level III, retrospective comparative study. Keywords: arthrodesis, functional outcomes, metatarsophalangeal Introduction Arthrodesis is a well-recognized procedure for the treatment of advanced degeneration of the first metatarsophalangeal joint (MTP joint), or as a salvage procedure after other joint-preserving interventions have failed.8,10,21 This technique was first described by Broca in 1852, with a number of studies describing the functional outcomes of this procedure and its association with technique, etiology of degeneration, concomitant procedures, and fixation method since that time.2-4,7,9,11,13,15-17 The majority of these series describe the experience of a single or small group of surgeons using a single technique. Various fixation methods have been utilized to achieve a successful arthrodesis, with union rates ranging from 77% to 100%.16,21 Physicians should consider all options when evaluating and treating patients with a degenerative first MTP joint. If nonoperative modalities fail (depending on the clinical and radiologic presentation), operative options include cheilectomy, excisional arthroplasty, first metatarsal osteotomy, implant or interpositional arthroplasty, and arthrodesis, with the goal of providing long-term pain relief and stability of the first ray.9 Arthrodesis is indicated for the treatment of severe degeneration of the first MTP joint, such as in grade 4 hallux rigidus, posttraumatic arthritis, inflammatory and neuromuscular conditions, failed cheilectomy, or severe hallux valgus.4,21 1 Hospital for Special Surgery, New York, NY, USA Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA 2 Corresponding Author: Bridget DeSandis, BA, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. Email: desandisb@hss.edu http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016