Metatarsophalangeal Fusion Techniques with First Metatarsal Bone Loss/Defects

First metatarsophalangeal joint disorder is a common cause of chronic forefoot pain that is frequently encountered in the orthopedic clinic. Numerous surgical techniques have been described to improve patient pain and function in this regard, including prosthetic joint replacement, resection arthroplasty, and arthrodesis. When these procedures fail, surgeons can be confronted with significant first metatarsal bone loss/defects. First metatarsophalangeal joint fusion remains the gold standard, and, in the setting of significant bone loss, the use of structural bone graft must be considered in order to restore length to the first ray and the normal biomechanics of the foot.