First MTP Joint Arthrodesis

Indications

Hallux Rigidus, radiograph of hallux rigidus
Radiograph of hallux rigidus. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 4.0.
  • Advanced hallux rigidus
  • Severe or recurrent hallux valgus
  • Rheumatoid forefoot
  • Salvage of failed surgery
  • Neuromuscular disease with hallux deformity
  • Hallux varus after previous surgery

Position

  • Supine, ankle tourniquet
  • Bump under the ipsilateral hip to bring the foot to neutral
  • Image intensifier available

Operative Steps

  1. Dorsal or medial approach, protecting the dorsomedial cutaneous nerve
  2. Prepare joint surfaces with cup and cone reamers
  3. Position in about 10 to 15 degrees valgus and neutral rotation
  4. Dorsiflexion so the pulp just clears a flat plate when loaded
  5. Fix with a lag screw and dorsal plate
  6. Release the collateral ligaments and remove osteophytes to deliver the joint
  7. Drill the subchondral bone to promote fusion
  8. Hold provisionally with K wires and check position on a flat plate and image intensifier
  9. Bone graft for defects after failed arthroplasty

Postoperative Care

  • Heel weight bearing for about 6 weeks
  • Radiographs at 6 and 12 weeks
  • Return to normal shoes at about 8 to 10 weeks
  • Union rates above 90% with modern fixation

Complications

  • Nonunion
  • Malposition, too much dorsiflexion causes shoe pressure
  • Interphalangeal joint arthritis
  • Symptomatic hardware
  • Malposition in varus causes pressure on the second toe
  • Infection and wound breakdown
  • Transfer metatarsalgia

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.