Technique and pearls in performing the first metatarsal phalangeal joint arthrodesis

When there is a considerable loss of first metatarsal phalangeal joint (MTPJ) motion and/or ankylosis is apparent then a joint preservation procedure may not be feasible. For end-stage degenerative change within the MTPJ, nonreducible joint incongruity, or instability of the first MTPJ, an arthrodesis can provide the most predictable and, arguably, the most definitive correction of the deformity, especially in patients with higher functional demands. This article discusses principles of techniques with an emphasis on the procedure to prepare a successful arthrodesis, and expounds on technical nuances including those associated with fixation devices.