First Metatarsal Pathology: Can An Implant Provide A Long-Term Solution?

By Kerry Zang, DPM, Shahram Askari, DPM, A’Nedra Fuller, DPM, and Chris Seuferling, DPM

However, minimal osseous resection is critical in order to preserve the sesamoid apparatus as well as the flexor/extensor function. Since this is a joint destructive procedure, surgeons must resect the prominent dorsolateral, dorsal, dorsomedial and medial aspects of the metatarsal to exactly match the circumference of the metatarsal component. Removing this bone will minimize the possibility of osseous impingement and diminish the potential for recurrent bony overgrowth.
Mark the center of the respective medullary canals with an awl through the centering guides in order to facilitate acceptance of the implant stems. Drill a guide hole with a football/egg shaped burr parallel to the shaft of the respective bone. One may make this evacuation in the presence of any previous fixation or other implanted device (wire/anchor), provided there is sufficient osseous structure for the implant stem support.
Use the implant sizers to ensure proper implant selection and to estimate the range of motion within the joint. When there are some questions as to which implant size to choose (large or small), we feel the best outcome is achieved with the smaller size. This allows the surgeon to skive off any additional overhanging bone, further minimizing the possibility of bony overgrowth.
Following proper implant selection, proceed to resect any overhanging bone on the metatarsal about the trial flanges to prevent impingement. When properly seated, the head of the metatarsal component should be slightly shorter clinically than the second metatarsal head. This allows for minimal disruption of the weightbearing surface of the first metatarsal and preserves the metatarsal parabola.
Double-check the range of motion within the joint. Copiously irrigate the operative side and place the implants within the appropriate impactor. Again, check the range of motion within the joint and close the capsule with the suture of choice. If the extensor hallucis is contracted, one may lengthen it to a functional position. Close the tissue layers and secure them according to preference. Apply a mild compression with the hallux placed in a functional position.
Another key to the success of the Bio-Action Implant is immediate, postoperative, passive range of motion. Daily sagittal plane range of motion exercises, performed by the patient or caregiver, are crucial to minimizing the length of the overall recovery period.


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