Patient-reported and radiologic outcomes of arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in elderly patients compared with proximal supination metatarsal osteotomy.

Abstract

There is no study regarding the difference in outcomes between arthrodesis of the first metatarsophalangeal joint (1-MTPj) and a metatarsal osteotomy for hallux valgus (HV). This study aimed to retrospectively examine the radiological parameters and patient-reported outcomes of arthrodesis of the 1-MTPj compared with a proximal supination osteotomy for severe HV in elderly patients. The series consisted of 15 feet treated with arthrodesis of 1-MTPj (AD group) and 15 feet treated with a proximal supination osteotomy (MO group). Radiographic parameters, the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score, and a visual analog scale pain score (VAS-PS) were analyzed preoperatively and at a minimum follow-up of 12 months with a median of 22 months. Patients in the two groups were matched by age, gender, BMI, the duration of follow-up, preoperative HV angle (HVA), and preoperative intermetatarsal angle (IMA) between the two groups (P > 0.1 for all comparisons). Preoperative HVA and IMA in the two groups were significantly improved postoperatively (P < 0.001 for both groups). There was no significant difference in postoperative HVA between the two groups, although postoperative IMA in the AD group was significantly greater than that in the MO group (P < 0.001; P = 0.178). All preoperative subscale scores of the SAFE-Q except the subscale for social functioning in the MO group significantly improved in the two groups postoperatively (P < 0.01). No significant differences in all postoperative subscale scores of the SAFE-Q except the subscale score for social functioning (P = 0.003) and postoperative VAS-PS were observed between the AD and MO groups (P > 0.1 for all comparisons). None of the feet had nonunion, infection, or breakage of hardware in both groups. Arthrodesis of the 1-MTPj is a viable procedure for elderly patients in whom correction of severe HV deformity seems to be difficult with joint-preserving procedures for HV.