Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2021; 12(7): 485-494
Published online Jul 18, 2021. doi: 10.5312/wjo.v12.i7.485
Arthrodesis of the first metatarsophalangeal joint: The “when and how”
Panagiotis Koutsouradis, Olga D Savvidou, Emmanouil D Stamatis
Panagiotis Koutsouradis, Emmanouil D Stamatis, Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Athens 16675, Greece
Olga D Savvidou, First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, “ATTIKON” Hospital, Athens 12462, Greece
Author contributions: Koutsouradis P performed the literature search and wrote the manuscript; Savvidou OD assisted in the literature search and in the final editing of the manuscript; Stamatis ED supervised the whole project and has the courtesy of the figures provided in the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: Nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Panagiotis Koutsouradis, MD, MSc, Surgeon, Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Ilias 8-12, Glifada, Athens, Athens 16675, Greece.
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: April 6, 2021
Revised: April 18, 2021
Accepted: July 12, 2021
Article in press: July 12, 2021
Published online: July 18, 2021

Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.

Keywords: First metatarsophalangeal joint arthrodesis, Indications, Surgical techniques, Complications

Core Tip: Disorders of the first ray are quite common in foot and ankle surgery, as multiple pathologies can lead to degeneration and may cause stiffness to the first metatarsophalangeal (MTP) joint. If non-operative treatment fails, arthrodesis of the first MTP joint is a well-established surgical option which has demonstrated very satisfactory results. Herein, we examine the various indications for this procedure, and the different surgical techniques, regarding joint preparation and fixation constructs, that we have at our disposal in order to obtain optimum results.