Geoffrey Watson, MD Matthew McKean, MD Siddhant K. Mehta, MD Thom A. Tarquinio, MD

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1 Geoffrey Watson, MD Matthew McKean, MD Siddhant K. Mehta, MD Thom A. Tarquinio, MD University of Mississippi Medical Center Jackson, Mississippi American Orthopaedic Foot & Ankle Society ANNUAL MEETING 2013 July 17 th -20 th

2 Geoffrey Watson, MD Matthew McKean, MD Siddhant K. Mehta, MD Thom A. Tarquinio, MD University of Mississippi Medical Center Jackson, Mississippi OUR DISCLOSURE IS IN THE FINAL AOFAS PROGRAM BOOK WE HAVE NO POTENTIAL CONFLICTS WITH THIS PRESENTATION

3 First metatarsophalangeal (MTP-1) joint arthrodesis is an acceptable treatment for hallux valgus in patients with recurrent deformity, inflammatory arthritis, neuromuscular conditions, severe deformity, or degenerative joint disease. Recent literature suggests MTP-1 arthrodesis alone does not adequately address metatarsus primus varus, thus requiring an additional procedure proximally (Lapidus procedure or Mau osteotomy) to further correct the wide IMA 1-2. Conversely, previous studies have stated that following a MTP-1 fusion for hallux valgus, the IMA 1-2 corrects enough that additional procedures are unnecessary. Unfortunately, this literature that supports the notion that arthrodesis alone includes all degrees of hallux valgus (mild to severe) and does not adequately represent the severe subset of patients that have extreme 1-2 intermetatarsal angles. It is our contention that adequate correction of IMA through MTP-1 arthrodesis alone for patients with severe deformity provides satisfactory patient outcomes.

4 Retrospective radiographic review of single surgeon series of patients with severe hallux valgus who underwent MTP-1 arthrodesis was performed. Severe hallux valgus was defined as HVA > 40 and IMA >15. A total of 19 feet (17 patients) were included Pre- and postoperative weight-bearing radiographs were analyzed for HVA and IMA 1-2 by three independent reviewers (attending orthopaedic surgeon, PGY-4 resident, PGY-3 resident) in blinded fashion. Descriptive statistics were obtained and paired t-test was performed to compare mean pre- and postoperative values using SPSS statistical analysis software. The level of significance was set at α=0.05. Data is reported as mean ± standard deviation.

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7 Mean follow up: months IMA 1-2 had significantly improved from ±2.82 preoperatively to ±2.89 postoperatively (p<0.001), with a mean correction of 8.32 ±3.02. HVA angle had significantly improved from 48.8 ±6.7 preoperatively to ±4.94 postoperatively (p<0.001), with a mean correction of ±6.47.

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9 First MTP arthrodesis for patients with severe hallux valgus is a feasible treatment strategy to achieve radiographic correction of the IMA 1-2. Following arthrodesis, the residual IMA 1-2 was degrees, very close to normative values cited in previous literature to be less than 9 degrees. We do not feel that this minimal amount of residual angulation is clinically significant. A prospective randomized trial to compare these two treatment options clinically would best delineate the proper treatment algorithm.

10 1. Coughlin, MJ. Hallux Valgus: An Instructional Course Lecture. AAOS. JBJS 1996, 78: Coughlin MJ, Grebing BR, Jones CP. Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results. Foot Ankle Int. 2005;26: Lipscomb PR. Arthrodesis of the first metatarsophalangeal joint for Sever Bunions and Hallux Rigidus. Clin Orthop Relat Res. 1979; 142: Grimes JS, Coughlin MJ. First Metatarsophalangeal Joint Arthrodesis as a Treatment for Failed Hallux Valgus Surgery. Foot Ankle Int. 2006;27: Pydah, SK; Toh, EM; Sirikonda, SP; Walker, CR: Intermetatarsal Angular Change Following Fusion of the First Metatarsophalangeal Joint. Foot Ankle Int. 30: , Cronin JJ, Limbers JP, Kutty S, Stephens MM. Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus. Foot Ankle Int. 2006;27: Rippstein, PF et al. Combination of First Metatarsophalangeal Joint Arthrodesis and Proximal Coreection for Severe Hallux Valgus Deformity. Foot Ankle Int. 2012