Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis: A Retrospective Radiographic Analysis

Abstract

The development of hallux interphalangeal joint (IPJ) arthritis after an arthrodesis of the first metatarsophalangeal joint has been established in the literature. However, the significance has not been well reported. A retrospective, radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. The Coughlin classification for degree of arthritic degeneration, hallux abductus angle, and hallux interphalangeus angle were measured in 107 radiographs of 103 patients preoperatively and postoperatively. Postoperative angles were measured immediately following surgery at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. We found that the hallux abductus angle had decreased in the patients postoperatively; however, the hallux abductus interphalangeus angle increased on average after first metatarsophalangeal fusion. The majority of patients started with a Coughlin classification I of the hallux IPJ, which remained unchanged over the postoperative period, with no statistically significant difference in IPJ degeneration in the patients with or without fusion of the first metatarsophalangeal joint. In addition, no patients had a symptomatic hallux IPJ postoperatively within our limited study period. Further prospective studies would be beneficial with longer follow-up times to assess IPJ degeneration following first metatarsophalangeal joint fusions. Levels of Evidence: Level III: Retrospective, comparative study

Neuropathic first metatarsophalangeal arthrodesis: Deforming force of flexor hallucis longus tendon

“…Although the discussion has been centered around the hallux valgus patient population, there are still studies that support the deformity of the HIPJ following 1 st MPJ arthrodesis treated for hallux limitus [8,9]. These findings with our results further support our theory that the FHL is the primary pathologic deforming force on the distal phalanx following 1 st MPJ arthrodesis in the neuropathic patients.…”

“…The degree of deviation at the HIPJ following 1 st MPJ arthrodesis is not a new finding [8,9]. However, the treatment for these patients with hallux interphalangeus after 1 st MPJ arthrodesis is challenging to treat.…”

“…Some early post operative reports showcase a decrease in the ideal HIPJ angle on radiographs as early as 3 months postoperatively. Although the authors did not comment on the reason for the degree of deviation this early postoperative finding at the HIPJ is concerning [9].…”