McG 35: 1st MTPJ Arthrodesis

Question 1

1st MTPJ arthrodesis addresses what factors

Answer 1

1. angular deformities

2. instability of 1st ray

Question 2

indication for 1st MTPJ arthrodesis

Answer 2

• severe or recurrent hallux valgus
• hallux rigid
• failed implant arthroplasty
• hallux varus
• 1st MTPJ osteoarthritis
• post traumatic arthritis
• inflammatory or septic arthritis
• neuromuscular conditions

Question 3

what determines success for an arthrodesis

Answer 3

1. joint preparation

2. stable fixation

Question 4

what is the surgical goal of 1st MTPJ arthrodesis

Answer 4

relief pain and stable positional realignment of the 1st ray on all body planes

Question 5

what is the advantage of arthroplasty type procedures

Answer 5

• relieving pain and allowing a degree of flexibility. This permit a wider shoe selection
• no need for post-op immobilization

Question 6

what is a disadvantage of 1st MTPJ arthroplasty

Answer 6

• weaker hallux for propulsion

- potential for progressive shortening of the resected bony segments over time

Question 7

advantage of arthrodesis of the 1st MTPJ

Answer 7

-a more rigid and permanent correction; no further bone shortening or resorption can occur

Question 8

1st MTPJ arthrodesis position

Answer 8

• slightly dorsiflexed away from the WB surface in the sagittal plane
• parallel, but not touching the 2nd toe on the transverse plane
• nonrotated on the frontal plane

Question 9

what happens if the hallux is plantarflexed

Answer 9

causes the foot to every as the hallux prematurely contacts the ground, resulting in painful pressure point/callosities at the plantar IPJ of the hallux and head of the 5th MT

Question 10

how should the hallux be placed in the sagittal plane

Answer 10

slightly dorsiflexed than neutral position relative to the WB surface

Question 11

shoe heel height

Answer 11

< 1 inch

Question 12

if 2nd toe digital corrections are performed simultaneously with 1st MTPJ arthrodesis, which should be corrected first

Answer 12

2nd toe

Question 13

what happens if the hallux is in an overly adducted position

Answer 13

increase the change for rigid hallux what

Question 14

how do you assess frontal plane rotation of the hallux

Answer 14

• examine the non-deformed nail

- the non deformed hallux digital nail is parallel to the plantar IPJ conduces, aiding frontal plane position

Question 15

indications for hallux IPJ sx

Answer 15

• malaligned

- arthritic

Question 16

hallux IPJ surgical procedures

Answer 16

• arthroplasty w/ resection of the head of the proximal phalanx
• arthrodesis of the IPJ
• flexor hallucis tenotomy w/ or w/p plantar capsulotomy

Question 17

complications of 1st MTPJ arthrodesis

Answer 17

• malposition
• nonunion
• additional strain at the hallux IPJ