1 st MP Arthrodesis. - Unraveling The Myths - Craig A. Camasta, DPM Atlanta, Georgia, USA
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1 1 st MP Arthrodesis - Unraveling The Myths - Craig A. Camasta, DPM Atlanta, Georgia, USA
2 Hallux Limitus Dorsal Bunion Spasm of Short Flexor Immobility of Sesamoids DJD of 1 st MPJ
3 Hallus Limitus Plantar Tyloma Hallux IP Joint Transfer Metatarsalgia 2 nd MP Joint
4 1 st MPJ Axis of Motion Normal Function Central in Metatarsal Head Changes With Position of Joint (Cam) Sagittal Plane Gliding
5 1 st MPJ Axis of Motion Sesamoid Immobility Plantar Shift of Axis Fixed Position Hinge Motion (Fulcrum)
6 Sesamoid Immobility Plantar Axis (S-P Ligament) Dorsal Impingement & DJD Plantar Cartilage Spared Crista Furrowing
7 Hallux Equinus Gripping of the Proximal Phalanx Provide Medial Stability Spasm of Short Flexors
8 Hallux Equinus Functional Fusion of MPJ Straight-line Dorsal Cortices Long Medial Column Apparent Met Primus Elevatus
9 Hallux Equinus or Metatarsus Primus Elevatus?
10 Varus (any level )
11 Hallux Equinus - Secondary Elevatus
12 Sesamoid Hypertrophy & Osteopenia Chronic Traction Reactive BoneProliferation Correlates to Degree of MPJ DJD Predictor of Salvageability
13
14
15
16
17
18 Relative Joint Surface Area Normal Surface Area M-P Joint 60% M-S Joint 40% Hallux Limitus Rigidus M-P Joint 40% M-S Joint 60%
19 Sesamoid Hypertrophy
20 Hallux Limitus / Rigidus Surgical Tx Elimination of Motion Fusion Restore Motion Resection Arthroplasty + / - Implant Cheilectomy/Osteotomy Alter Joint Position Osteotomy
21 61F Painful Hallux Rigidus
22 Cheilectomy + Osteotomy
23 Indications for 1 st MP Fusion Hallux Rigidus no joint space, sesamoid fusion Hallux Valgus with DJD Chronic / Recurring Gout Failed Prior Surgery (cheilectomy, implant, etc) Hallux Varus (resistant to flexible reduction) Hallux Equinus (spasm of FHB, sesamoid retraction) Neurologic Deformity Complex Forefoot Deformities
24 1 st MP Joint Range Of Motion Degrees Required For Normal Gait Based on Disability Rating Available ROM NORMAL GAIT Less than 10 Degrees (Hetherington, et al.)
25 Controversies With 1 st MP Fusion I need 65 degrees of motion No you don t!!! You have a painful stiff joint in a bad position we will give you a painfree stiff joint in a more functional position Can I wear high heel shoes? -- you will be able to wear anything after surgery that you can wear now, it just won t hurt to wear them Can I run and exercise? You will be able to do everything that you do now, it just won t hurt to do it
26 1 st MP Joint Fusion 1 st MPJ Fusion Motion = Pain Metatarsal-Sesamoid Joint Adjacent Joint DJD Position, Position, Position
27 1 st MP Fusion
28 Position of Fusion
29 Position of Fusion Dorsal Hallux Parallel to Corrected 2 nd Toe Lateral Hallux Parallel to Ground (just barely touching ground) Foot Maximally Pronated (Simulates Late Midstance)
30 Sagittal Angle of Fusion??? Different in Every Foot Hallux Proximal Phalanx Parallel to Ground As Soon As Heel-Off Hallux IPJ Purchase
31 1 st MP Fusion
32 Post-Op Year 4 Fusion
33 1 st MP Fusion PO Year 7
34 Hallux Valgus / Rigidus
35 Fusion - Metatarsal/Phalanx/Sesamoids
36 Fusion Metatarsal/Phalanx/Sesamoids
37 Ultimate Bunion Procedure
38 Salvage Procedure Failed Hallux Limitus / Valgus Surgery Cheilectomy Osteotomy Implant AVN Complex Forefoot Derangement
39 Hallux Valgus Varus Fusion
40 Failed Implant - POW 8 Graft + LP
41 Severe HAV, Obese, Ni Allergy
42 Pre & POM 3 (FWB)
43 (SM) Post Op Year 1
44 Locking Screws / Plates + Bone Graft
45 Complex Forefoot Derangement Forefoot Effect on Rearfoot Spastic FHB Tendon Volkman s Ischemic Contracture post Compartment Syndrome
46 Post Traumatic Compartment Syndrome Hallux Equinus
47 Range of Motion Examination
48 Post-Op 1 st MP Fusion
49 Metatarsus Primus Elevatus?
50 1 st MP Fusion / Pan Met Head Resection
51 Pre-Op and Post-Op Year 4
52 62 Female HAV/HR
53 Pre and Post
54 POM 6 B/L 1 st MP Fusion
55 52 Male Prior Osteotomy/Cheilectomy
56 1 st MP Fusion
57 Gait (left foot)
58 Toe-Raise (left foot)
59 45 M B/L Hallux Limitus + GOUT
60 Post B/L 1 st MP Fusion
61 Gait Post B/L Fusion
62 (NG) 60F Painful B/L Hallux Rigidus
63 Hallux Equinus / Rigidus
64 Post Op B/L 1 st MP Fusion
65 Gait Barefoot B/L 1 st MP Fusion
66 Gait Shod B/L 1 st MP Fusion
67 (AW) POM 9 Mitchell Nerve Entrapment
68 (AW) POY 3-1 st MP Fusion
69 Nightmare
70 Pre & Post Gait
71 1 st MP Fusion - Summary Normal Gait Requires NO MOTION NEUTRAL Position of Fusion Remember the SESAMOIDS WB to Tolerance Primary & Salvage Procedure
19 Arthrodesis of the First Metatarsocuneiform Joint
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