A Guide To First MPJ Arthrodesis For Active Patients

By Lawrence A. DiDomenico, DPM, and Alfonso A. Haro III, DPM

   Surgical recommendations are sparse when evaluating treatment options for the athletic population diagnosed with hallux limitus, hallux rigidus or first metatarsophalangeal (MPJ) osteoarthritis. However, we have found success in treating athletes with first MPJ arthrodesis, and helping them to achieve pain relief and a return to activities.    Several surgeons have found similar success as evidenced by a review of the literature on this subject. In 1996, Bouche, et. al., advocated first MPJ arthrodesis in active patients, reporting that it could “relieve pain and allow patients to perform some athletic function (including running).”1 They performed first MPJ arthrodesis for five individuals who ranged from 42 to 57 years old and each patient returned to his or her respective preoperative weightbearing activity. The daily activities of these patients included walking, exercise, race walking, power walking and running.    While there is still controversy on whether one should perform first MPJ arthrodesis in the active population, Bouche says the first MPJ arthrodesis is the preferred joint destructive procedure in active patients and is a “definitive, predictable and viable option.”1    In 2005, Brodsky, et. al., presented results of a retrospective study and indicated that “patients with a first MPJ fusion function extremely well and most athletic patients continue participating in sports with the advantage of greatly diminished discomfort.”2 Surgeons performed a first MPJ arthrodesis on 53 patients (60 feet), who ranged between 21 to 79 years old. These patients engaged in weightbearing activities ranging from activities of daily living to recreational sports and exercise.2 The researchers performed postoperative functional testing on 45 patients. Of those 45 patients, 64 percent could stand on their tiptoes, 94 percent could kneel, 87 percent could squat and 98 percent could pick up a small object from the floor.2    The following are the results of patient answers to a functional questionnaire.2    • 100 percent could ascend stairs    • 96 percent could descend stairs    • 100 percent could walk less than one block    • 96 percent could walk one to six blocks    • 90 percent could walk over six blocks    • 75 percent returned to jogging    • 80 percent returned to golfing    • 92 percent returned to hiking    • 75 percent returned to tennis    • 98 percent returned to work    • 45 percent had no shoe limitations    • 47 percent required comfort shoes    • 8 percent required prescription insoles    Brodsky, et. al., described arthrodesis of the first MPJ as “a successful surgical procedure that provides relief of pain, correction of deformity and allows a high level of function in everyday life and in recreational activities.”2

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