Arthrodesis Techniques for First Metatarsophalangeal Joint Stabilization
Summary
Arthrodesis of the first metatarsophalangeal (MTP) joint is established as the definitive procedure to alleviate pain and deformity in conditions such as hallux rigidus and severe hallux valgus. The technique involves surgical fusion of the first metatarsal head to the base of the proximal phalanx, thereby eliminating joint motion and redistributing loads through adjacent structures. Joint preparation methods range from planar and conical excision to cup-and-cone reaming, with the latter designed to maximise surface contact and promote rapid osseous union. Fixation constructs have evolved from simple lag screws and K-wires to dorsal and medial locking plates combined with interfragmentary compression screws, shape-memory staples or fully threaded devices. Biomechanical investigations consistently demonstrate that combined plating and compression screw constructs yield superior stiffness, while emerging designs such as wedge resections and novel locking implants show promise in enhancing stability without compromising bone stock. Clinical protocols have shifted toward early weight-bearing in rigid‐sole footwear, although biomechanical data suggest some constructs remain insufficient to tolerate full load immediately. Across diverse patient populations, reported union rates exceed 90%, with low non-union and hardware removal rates, underscoring the global significance of first MTP arthrodesis in restoring function and quality of life.
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Arthrodesis Techniques for First Metatarsophalangeal Joint Stabilization publication trend
The graph below shows the total number of articles in arthrodesis techniques for first metatarsophalangeal joint stabilization across all publications each year (not limited to Nature Index journals).
Technical terms
Arthrodesis: Surgical fusion of a joint to eliminate movement and alleviate pain.
Interfragmentary compression screw: A screw designed to draw two bone fragments together to enhance stability and promote fusion.
Dorsal/medial locking plate: Rigid metal plate secured to either the top or inner side of the joint, with locking screw heads to prevent loosening.
Cup-and-cone preparation: Joint surface resection method creating complementary concave and convex surfaces for maximal bone contact.
Wedge resection: Bone excision technique removing a triangular segment to increase biomechanical stiffness of the fusion site.
References
- Evaluating the Biomechanical Integrity of Various Constructs Utilized for First Metatarsophalangeal Joint Arthrodesis: A Systematic Review. Materials (2023).
- Weight-bearing recommendations after first metatarsophalangeal joint arthrodesis fixation: a biomechanical comparison. Journal of Orthopaedic Surgery and Research (2017).
- First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution. Cureus (2021).
- First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques. Journal of Foot and Ankle Research (2022).
- First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation. Cureus (2017).
- Effect of lag screw on stability of first metatarsophalangeal joint arthrodesis with medial plate. PeerJ (2024).
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