2017 HONORABLE MENTION

Severe hallux valgus is a common condition that involves pain and limited range of motion of the first metatarsophalangeal (MTP) joint and frequently is associated with degenerative arthritis. Nonsurgical management, such as activity modification, stiff-soled shoes, orthotics, NSAIDs, and cortisone injections, is effective only for a short period of time. Common surgical management techniques include proximal or distal osteotomy with extreme bone translation that can be performed in combination with other joint-sparing procedures, such as cheilectomy, phalangeal osteotomy, and shortening first metatarsal osteotomy. Despite surgical management, pain, limited range of motion, and functional impairment often remain.

Although few studies are available in the literature, arthrodesis of the first MTP joint is a reliable treatment option for the management of severe hallux valgus, resulting in good to excellent outcomes. Arthrodesis of the first MTP joint can be performed using various techniques, and a mean union rate of approximately 90% after arthrodesis of the first MTP joint has been reported in the literature. Postoperatively, the patient is allowed to bear weight on their heel with the use of a postoperative shoe and allowed to walk flatfooted after radiographic healing occurs (typically 4 to 6 weeks postoperatively). Potential complications of arthrodesis of the first MTP joint include general surgery risks associated with anesthesia, infection, nerve damage, and bleeding. Complications specific to MTP fusion include delayed bone healing, malunion, nonunion, and stiffness in nearby joints. Inclusion criteria for our study were a hallux valgus angle greater than 40°, age older than 70 years, no previous bunion procedures, minimum follow-up of 2 years, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score administered preoperatively. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved significantly. Overall, patient satisfaction was excellent to good. No foot was rated fair or poor. No recurrence or complications were recorded.

In conclusion, MTP arthrodesis is a reliable and successful procedure for the correction of severe hallux valgus, especially in elderly patients, resulting in a high rate of bone fusion, a low rate of complications, no impairment of ambulation, and no need for a special postoperative rehabilitation protocol.