Analysis of the clinical score progressions during the first year after first MTPJ fusion

Arthrodesis of the first metatarsophalangeal joint is an effective procedure for many foot pathologies. Many studies have focused on the moment at which joint fusion is carried out, or on the medium- and long-term outcomes. The aim of this study was to assess the clinical progression of patients, evaluating both pain and changes on the AOFAS scale at various points during the first postoperative year.

A prospective study with 49 patients was conducted. The AOFAS scale and pain was collect both preoperatively and at 3, 6, and 12 months after first metatarsophalangeal arthrodesis with 20-mm memory compression staples. The data obtained were analyzed for functional status and pain during the first year after surgery.

The mean preoperative AOFAS score was 39 compared with a mean postoperative score at 1-year followup of 85. The results of the AOFAS scale at 3- and 6-months post-surgery showed considerable variation. In contrast, at 12 months the mean results tended to converge, thus suggesting greater reliability in the prognosis. The change in pain over time differs from the AOFAS. Pain improved rapidly during the first 6 months; it peaked during the first 3 months, but the data suggests that it was from 6 months onward that prediction of pain levels begin to be more predictable and consistent.

The present results show that scores on the AOFAS scale and for pain improve progressively throughout the first year following first MTPJ fusion. At 3 months the results for both pain and the AOFAS scale had a low predictive value due to the wide variation in scores. However, at 6 months, pain stabilized and scores showed greater precision, thus increasing the predictive value of the results. With the AOFAS scale, there continued to be considerable variation at 6 months, and it was not until 1-year post surgery that scores showed an acceptable degree of precision.