From the Research
MTP fusion is not typically the first-line treatment for a foot with hallux valgus resulting from a nonunion after Lapidus surgery, but it may be considered in cases with significant arthritic changes or instability, or if previous attempts at revision have failed. The decision to proceed with MTP fusion depends on several factors, including the severity of symptoms, degree of deformity, joint damage, and patient's functional needs. Initially, revision of the failed Lapidus procedure (first tarsometatarsal fusion) would be considered to address the nonunion directly, as this approach has been shown to provide good clinical outcomes with low nonunion rates when performed with meticulous joint preparation and rigid fixation 1.
Some key considerations in the management of hallux valgus deformity and nonunion after Lapidus surgery include:
- The severity of the deformity and symptoms
- The presence of arthritic changes or instability in the first MTP joint
- The patient's functional needs and expectations
- The potential benefits and risks of surgical intervention, including MTP fusion
According to recent studies, the Lapidus procedure can provide excellent correction of hallux valgus deformity with minimal shortening of the first metatarsal, resulting in high patient satisfaction 2. However, nonunion rates can vary depending on the technique and fixation method used, with some studies reporting higher union rates with rigid cross screw fixation and meticulous joint preparation 1.
In cases where MTP fusion is considered, the procedure involves removing the remaining cartilage and permanently fusing the joint in a corrected position, providing good pain relief and correction of deformity but sacrificing joint motion. The recovery typically requires 6-8 weeks of non-weight bearing or protected weight bearing in a cast or boot, followed by gradual return to activities over 3-4 months. Before proceeding with any surgical intervention, conservative measures such as accommodative footwear, orthotics, and activity modification should be considered, especially for patients with minimal symptoms or those who are poor surgical candidates.