Footwear alterations after first metatarsophalangeal joint arthrodesis

Abstract

Objectives: This study aimed to examine the footwear alterations following first metatarsophalangeal (MTP1) joint arthrodesis.

Methods: A retrospective review was performed on 37 (42 feet) patients who underwent MTP1 joint arthrodesis between January 2014 and January 2019 in our institution. Functional outcomes were assessed with the American Orthopedic Foot and Ankle Society Hallux metatarsophalangeal–interphalangeal (AOFAS-MTP-IP) scale, and the pain was assessed using the visual analog scale (VAS). Besides, time to return regular footwear, shoe preferences, the cosmetic appearance of the feet were evaluated and compared with preoperative status.

Results: The mean follow-up time was 12.0 ± 16.5 months. The preoperative AOFAS-MTP-IP scale improved from 46.6 ± 7.0 points to 86.2 ± 7.2 points (p =0.001), and VAS decreased from 6.3 ± 1.8 points to 1.4 ± 0.5 points (p =0.001). There was non-union in three (7.1%) feet, and the mean union time for the rest of the feet was 8.2 ± 1.1 weeks. No other complications were seen. The mean time for resuming regular footwear was 11.8 ± 2.6 weeks. Patients’ perception of the appearance of their feet improved from 3.9 ± 2.8 to 9.0 ± 0.7 points (p =0.001). Twenty-nine (78.6%) patients (33 feet) reported that there was no restriction in footwear compared to the past, but 8 (21.4%) patients had to choose specific types and models. None of the patients had to use modified or custom-made shoes. There was significant change in the heel height preferences after the surgery (p =0.004). 18 (52.4%) patients had to choose shorter heel height than preoperative preferences, whereas 19 (47.6%) patients’ preference did not change. Almost all patients, 36 (97.6%) were using athletic shoes in their routine daily life.

Conclusions: MTP1 joint arthrodesis is a reliable method that controls pain and increases function with a low rate of complications. However, significant alterations in footwear preferences may occur. Patients should be informed adequately about these outcomes to modify patient expectations.

Keywords

• Hallux valgus
• hallux rigidus
• arthrodesis
• footwear
• outcome

References

1. 1. Fuhrmann RA. First metatarsophalangeal arthrodesis for hallux rigidus. Foot Ankle Clin 2011;16:1-12.
2. 2. Wood EV, Walker CR, Hennessy MS. First metatarsophalangeal arthrodesis for hallux valgus. Foot Ankle Clin 2014;19:245-58.
3. 3. Stevens J, de Bot RTAL, Hermus JPS, van Rhijn LW, Witlox AM. Clinical outcome following total joint replacement and arthrodesis for hallux rigidus: a systematic review. JBJS Rev 2017;5:e2.
4. 4. DeFrino PF, Brodsky JW, Pollo FE, Crenshaw SJ, Beischer AD. First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int 2002;23:496-502.
5. 5. Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of hallux limitus on plantar foot pressure and foot kinematics during walking. J Am Podiatr Med Assoc 2006;96:428-36.
6. 6. Boissonnault WG, Donatelli RA. The influence of hallux extension on the foot during ambulation. J Orthop Sports Phys Ther 1984;5:240-2.
7. 7. Stevens J, Meijer K, Bijnens W, Fuchs MC, van Rhijn LW, Hermus JP, et al. Gait analysis of foot compensation after arthrodesis of the first metatarsophalangeal joint. Foot Ankle Int 2017;38:181-91.
8. 8. DeSandis B, Pino A, Levine DS, Roberts M, Deland J, O'Malley M, et al. Functional outcomes following first metatarsophalangeal arthrodesis. Foot Ankle Int 2016;37:715-21.

9. 9. Rajczy RM, McDonald PR, Shapiro HS, Boc SF. First metatarsophalangeal joint arthrodesis. Clin Podiatr Med Surg 2012;29:41-9.
10. 10. Dawson J, Boller I, Doll H, Lavis G, Sharp RJ, Cooke P, et al. Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study. Foot (Edinb) 2012;22:211-8.
11. 11. Coughlin MJ, Saltzman CL, Nunley 2nd JA. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot and Ankle Society on angular measurements. Foot Ankle Int 2002;23:68-74.
12. 12. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology and radiographic assessment. Foot Ankle Int 2003;24:731-43.
13. 13. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53.