Is First Metatarsophalangeal Joint Fusion Appropriate in Younger Patients?

A study in Foot and Ankle International found that first metatarsophalangeal joint fusion yielded highly satisfactory and similar outcomes in patient cohorts younger than 50 and older than 60 years of age with end-stage degeneration of that joint.¹ The authors followed these patients to an average of 14 years postoperatively. Although traditionally end-stage degenerative joint disease is more common among patients of advanced age, the researchers explored how younger candidates fared with MTP I arthrodesis, widely considered the gold standard procedure for this diagnosis.¹ Interestingly, the authors state that their original hypothesis was that the younger patient population would experience worse pain and function scores with overall inferior outcomes.

Patients who underwent surgery between 1995 and 2012 were among those studied, for a total of 61 fusions in 46 patients (28 under the age of 50, and 33 over the age of 60).¹ The authors used the Tegner activity score (TAS), a “Virtual” Tegner activity score (VTAS), visual analog scale (VAS) and Foot Function Index (FFI) as outcome measures.

Upon analyzing the data, they found that the younger cohort exhibited better pain relief (via the VAS and FFI Pain subscale) from the procedure than their older matched cohort.¹ Functional outcomes did not yield any significant differences between the groups. Achieving the ability to have the desired functional outcomes, expressed using the ratio of TAS to VTAS was also similar between the two sets of patients. Need for hardware removal was more likely in the younger group, but revision rates as a whole remained comparable.¹

Reference

1. Scheurer F, Zimmermann SM, Fischer P, Wirth SH, Beeler S, Viehöfer AF. Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients. Foot Ankle Int. 2023;0(0). doi:10.1177/10711007231205567