Return to Physical Activity and Footwear Modifications After First Metatarsophalangeal Joint Arthrodesis, Including...

First metatarsophalangeal (MTP) arthrodesis can effectively alleviate pain and correct deformity of the great toe but may introduce unique limitations to an active patient population, particularly in alpine-specific sports including Nordic and alpine skiing, snowboarding, hiking, trail running and biking. Limited literature evaluates return to these specific activities after first-MTP arthrodesis. This study aims to better define the ability to return to physical activity, with a focus on alpine sports and footwear modifications.

Adults undergoing MTP arthrodesis with ≥1-year follow-up at a single academic institution were retrospectively reviewed. Demographic data, surgical complications, and radiographic union were recorded. A custom sports questionnaire was administered preoperatively and postoperatively across >20 sports, including outdoor and alpine sports, to assess return to activity. Paired t tests compared pre- to postoperative changes in patient-reported outcomes, with significance set to P <.05.

The mean age was 58.8 years, and 57.3% were female. Ninety-six percent (43/45) of patients returned to sport by 12 months postoperatively, whereas 24.4% required more than 12 months to reach their maximum activity level. Nordic and alpine skiers and snowboarders were all able to return to the same or higher level of sport, but nearly half (40%) required boot modifications. Similarly, 42% of all patients in this study required some level of shoe modification for their respective sport.

First-MTP arthrodesis supports high return-to-sport rates, including demanding alpine activities including skiing, snowboarding, and hiking. Up to 1 year is often required to reach maximum performance. Patients should be counseled on the potential need for footwear modification after surgery. These findings outline guidance for counseling of highly active patient populations. Further studies can help elucidate which factors contribute to the lack of return to sport for specific patients and sports.

Level IV, retrospective case series.