Pearls on Performing First MTPJ Arthrodesis

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My name is Brad Abicht based out of Gundersen Health System in La Crosse, Wisconsin.
 
Can you share any pearls on first MTPJ arthrodesis?
 
Yeah, I think the biggest thing I can share on this procedure is that at this point, we have a lot of options. So there are some key elements to the procedure that are pretty traditional but I think the fixation has advanced over time and some of our surgical techniques have advanced over time. And that's really what we're going to try and highlight in the upcoming ACFAS meeting.
 
Still extremely important to get the right position of the hallux when you're doing this procedure, no matter how you approach it. And you want to try and critically avoid over-shortening the hallux. or the first ray and I would say those are the two biggest pearls I would give surgeons and there's different ways to approach that or do that and that's what we're going to try and highlight.
 
What are some pitfalls for surgeons to avoid?  
 
Yeah, I think the biggest pitfall is to avoid a malunion. So the position of the hallux remains critical. Essentially, you know, you're looking to put that hallux into a neutral alignment in the frontal plane. You want some slight dorsiflexion, roughly 10 to 15 degrees, and then probably some slight valgus, about 5 to 10 degrees of valgus. And each patient's gonna be a little bit different, depending on their foot type and the pathology that you're correcting. But you wanna really pay attention to those general aspects of the position of the hallux of the great toe.
 
There's other techniques you can utilize to check that position by, you know, putting a flat pan underneath the foot and trying to load it intraoperatively to make sure you have the right position of the great toe. There's also certain fixation that helps get positioning these days as well, so different ways to double check that when you're when you're fusing the big toe joint.
 
I would also say you really want to try and avoid over-shortening the first ray. You know, whether you do this through an open approach, MIS or percutaneous, you really want to avoid over-shortening so you don't have other pathology that develops or biomechanical problems that develop after a great toe joint fusion. So that remains critical as part of the procedure.
 
A Closer Look at Interesting Recent Research and Innovative Techniques for First MTPJ Arthrodesis
 
Yeah, that's one thing when I was preparing my lectures was very interesting to see all the great literature out there. And like I mentioned before, it just really gives us a lot of options on how to approach an arthrodesis to the great toe. Again, every patient's situation is going to be a little different. It could be a primary procedure or revision procedure.
 
And depending on how you're going to approach it, it we do have new techniques out there that have been described in the literature. My group here at Gundersen had recently published in December of last year a percutaneous approach to great toe joint fusion and this is one thing we'll highlight at the upcoming ACFAS meeting but this is a way to leave a minimal surgical footprint for your patient and to do it through a percutaneous approach, which basically involves some very tiny poke hole incisions, typically leads to less postoperative pain compared to some of our open approaches for a great toe joint fusion.
 
There's less hardware involved and patients can immediately weight bear on their foot and provides a little bit quicker recovery with a high patient satisfaction. So this was published in Foot and Ankle Surgery: Techniques, Reports and Cases recently, just at the end of 2023. So I'd encourage people to check out that technique if they're interested.