First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes

Yvonne Chodaba ¹, Nicholas A Andrews ¹, Jared Halstrom ¹

⁰Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons +

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March 24, 2023

View abstract on PubMed

Summary

First metatarsophalangeal (MTP) joint arthrodesis yields similar patient-reported outcomes for hallux rigidus and hallux valgus. Increased MTP dorsiflexion may improve outcomes in hallux rigidus patients.

Area Of Science

Orthopedic Surgery
Podiatry
Biomedical Engineering

Background

Limited comparative data exists on patient-reported outcomes (PROMs) following first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus versus hallux valgus.
Investigating the influence of postoperative radiographic alignment on these outcomes is crucial for surgical optimization.

Purpose Of The Study

To compare PROMs between patients with hallux rigidus and hallux valgus undergoing primary MTP arthrodesis.
To assess the correlation between postoperative first MTP joint alignment and patient outcomes within each pathology group.

Main Methods

Retrospective review of 98 patients who underwent primary MTP arthrodesis (January 2010 - March 2020).
Patients were categorized into hallux rigidus (n=37) and hallux valgus (n=61) groups based on preoperative radiographs.
PROMs including Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and Foot Function Index (FFI) revised short form were collected via telephone.

Main Results

No significant differences were observed in wound complications, radiographic union, or revision surgery rates between the hallux rigidus and hallux valgus groups.
At a median follow-up of 2.4 years, PROMIS and FFI scores did not differ between the pathology groups and were comparable to the general US population.
In the hallux rigidus group, a greater postoperative first MTP dorsiflexion angle correlated with lower FFI Pain, FFI Total, and PROMIS Pain Interference scores.

Conclusions

First MTP arthrodesis provides comparable intermediate-term patient-reported outcomes for both hallux rigidus and hallux valgus.
Optimizing first MTP dorsiflexion during arthrodesis for hallux rigidus may lead to improved patient outcomes.
Further research is warranted to confirm the relationship between MTP dorsiflexion and patient-reported outcomes in hallux rigidus.

Keywords:

FFI Hallux rigidus MTP arthrodesis PROMIS hallux valgus