[Fusion of the first tarsometatarsal joint using a plantar tension band osteosynthesis]

Treatment of hallux valgus in patients with a pathology of the first metatarsocuneiform (MC) joint by a fusion of the first MC fixed by a plantar plate. The plantar plate has biomechanical advantages and has good soft tissue coverage by the M. abductor hallucis.

Instability or degenerative arthritis of the first MC joint in patients with hallux valgus.

Short first metatarsal.

Bone-saving resection of the first MC joint. Arthrodesis using a compression screw and a plantar interlocking plate. Distal soft tissue procedure and resection of the exostosis.

For 6 weeks, a long sole, post-operative shoe with weight bearing as pain allows. Mobilization of the first metatarsophalangeal joint when the wound healing is assured. Full weight bearing after 6-8 weeks in a normal shoe, when the bone healing is completed on the x-rays. No sports with high demands on the foot for 12 weeks. Orthotics only in cases with persisted pain or associated pathology.

In a case control study including 72 patients, a significantly lower rate of nonunion and soft tissue problems, compared to dorsal or medial plate positioning, was observed.