First metatarsocuneiform joint arthrodesis: a five-year retrospective analysis

Historically, first metatarsocuneiform joint arthrodesis has been advocated for severe metatarsus primus adductus deformity and as a salvage procedure in reconstructive forefoot surgery. At the Podiatry Hospital of Pittsburgh, the authors have expanded the use of this procedure to include elimination of excessive motion at the first metatarsocuneiform joint and to restore functional integrity to the first ray in an otherwise poorly functioning foot. First metatarsocuneiform arthrodesis has had poor acceptance by podiatric surgeons. Common reasons for this poor acceptance are technical difficulty associated with the procedure and often-cited complications such as shortening of the first ray, with symptomatic transfer lesions, as well as nonunion of the arthrodesis site. The authors evaluated 54 procedures. Results of first metatarsocuneiform joint arthrodesis for long-term reduction of the intermetatarsal angle and for limiting abnormal motion at this joint have been very good. Few complications were encountered. Shortening of the first metatarsal with secondary transfer lesions was not found to be a common problem. Several radiographic nonunions occurred, none of which were symptomatic. The surgical procedure, as it is performed at the Podiatry Hospital of Pittsburgh, is described. Results from a 5-year retrospective analysis of first metatarsocuneiform arthrodesis are presented.