Clinical Effect Of First Metatarsophalangeal Joint Fusion Combined With Metatarsophalangeal Joint Arthroplasty In The Treatment Of Hallux Valgus In The Elderly

Objective: The first metatarsophalangeal joint fusion is widely used to correct moderate to severe hallux valgus deformity.This study was used to observe the clinical and imaging efficacy of the first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty for the treatment of hallux valgus in the elderly;to obtain complete clinical and imaging results,to provide clinical data for clinicians to confirm and optimize the surgical method of hallux valgus in the elderly.Methods: We retrospectively analyzed the method of first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty used to treat 18 elderly patients with hallux valgus(20 feet)after the conservative treatment was ineffective from August 2013 to August 2017.Cases included in the study were required to have an angle of valgus(HVA)>30°,and the range between the first and second metatarsal angles was 13° to 24°,and the age was >65 years.A total of 18 subjects(20 feet)were enrolled in the study,including 1 male and 17 female,aged 65~77 years(mean age 72 years).There were 18 cases of left foot,2 cases of right foot and 2 cases were of both feet.All cases were combined with the second toe hammer toe,and 3 cases of the third toe hammer toe.Among them,18 patients underwent single foot surgery and 2 patients underwent double foot surgery.All patients were followed up until the complete recovery,and all subjects were followed up for an average of 14.5 months(9~24 months).During the follow-up,detailed physical and imaging examinations were performed.The relevant data were processed by SPSS19.0 software,P<0.05 was statistically significant.Results: All patients were followed up for 9~24 months.In 18 patients,the pain of the forefoot was relieved,the bunion disappeared,the toe valgus and hammer toe deformity were corrected,and the transverse arch of the forefoot was partially restored.At the last follow-up: HVA decreased from(39.5°±6.5°)before surgery to(16.5°±3.1°)after surgery,with an average decrease of 23°;IMA was preoperative(17.5°±4.4°)decreased to(10.3°±1.4°)after operation,with an average decrease of 7.2°;AOFAS score increased from the preoperative average(42.5±3.8)points to the postoperative average(80.2±3.2)points,and the difference was statistically significant(P<0.001).One patient had delayed wound healing,and the wound healed after regular dressing change and oral antibiotics,which did not affect the surgical outcome;One patient had limited movement of the metatarsophalangeal joint.After the active and passive functional training,the activity of the metatarsophalangeal joint returned to normal,and the patient was satisfied with the treatment.Conclusion: The first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty for the treatment of hallux valgus in elderly can not only reduce the hallux valgus angle and the first and second intercondylar angles,improve the postoperative AOFAS score,but also correct the forefoot dysfunction,restore the lateral arch of the forefoot and improve the shape of forefoot,reduce the recurrence rate of postoperative forefoot pain,improve patient satisfaction,and have good clinical promotion value.