From the Guidelines
An MTP fusion is recommended to treat hallux valgus after a nonunion Lapidus surgery, but only as a salvage procedure when other options have failed, as it provides good pain relief and deformity correction, but permanently eliminates motion at the joint. The decision to perform an MTP fusion should be based on the patient's specific clinical situation, including age, activity level, severity of deformity, and joint condition 1.
Key Considerations
- The initial approach usually involves revision of the Lapidus procedure with bone grafting to address the nonunion directly.
- MTP fusion becomes appropriate when there is significant arthritic change at the MTP joint, persistent pain, or when the deformity is severe and cannot be adequately corrected with revision surgery.
- The procedure involves removing the remaining cartilage from the joint surfaces, positioning the toe in proper alignment, and securing it with screws, plates, or other fixation devices.
- Recovery typically requires 6-8 weeks of protected weightbearing in a post-operative shoe or boot, followed by gradual return to regular footwear and activities over 3-4 months.
Alternative Options
- Achilles tendon lengthening in combination with an offloading device may be considered for patients with a neuropathic plantar metatarsal head ulcer for which non-surgical offloading treatment fails 1.
- Metatarsal head resection in combination with an offloading device may also be considered for patients with a neuropathic plantar metatarsal head ulcer for which non-surgical offloading treatment fails 1.
- Joint arthroplasty in combination with an offloading device may be considered for patients with a neuropathic hallux ulcer for which non-surgical offloading treatment fails 1.
Conclusion Not Applicable
Instead, the focus is on the patient's specific clinical situation and the potential benefits and drawbacks of each treatment option. The patient's age, activity level, severity of deformity, and joint condition should all be taken into account when deciding on the best course of treatment.
From the Research
Treatment Options for Hallux Valgus After Nonunion Lapidus Surgery
- The treatment for hallux valgus after a nonunion Lapidus surgery is a complex issue, and there are various options available, including revision fusion, removal of hardware and debridement, or MTP fusion 2.
- A study published in the Journal of Foot & Ankle International found that removal of hardware and debridement alone can be a reasonable option for treating nonunion after hallux MTPJ fusion, with outcome scores marginally worse compared to those with successful fusions 2.
- Another study published in the same journal found that the modified Lapidus procedure can result in a satisfactory clinical outcome in most patients, with a low rate of nonunion and malunion, but with potential complications such as hallux varus and midfoot stiffness 3.
MTP Fusion as a Treatment Option
- MTP fusion is a surgical procedure that involves fusing the metatarsophalangeal joint to correct hallux valgus deformity.
- A study published in The Journal of Foot and Ankle Surgery found that first MTPJ arthrodesis with a dorsal locking plate and compression screw construct can be an effective treatment for hallux valgus, but with a risk of nonunion, particularly in patients with diabetes or residual postoperative hallux valgus deformity 4.
- Another study published in the same journal found that modified Lapidus arthrodesis with crossed screw fixation can be a versatile and powerful procedure for correcting hallux valgus deformity, with a high rate of union and significant improvement in deformity correction 5.
Recommendations for MTP Fusion
- Based on the available evidence, MTP fusion may be recommended as a treatment option for hallux valgus after a nonunion Lapidus surgery, particularly in patients with significant deformity correction and no residual hallux valgus deformity 4.
- However, the decision to perform MTP fusion should be made on a case-by-case basis, taking into account the individual patient's needs and risk factors for nonunion, such as diabetes and residual postoperative hallux valgus deformity 4.
- Further research is needed to determine the optimal treatment approach for hallux valgus after nonunion Lapidus surgery, including the role of MTP fusion and other surgical procedures 6, 2, 3, 5, 4.