• INTRODUCTION
    • Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis.
  • STEP 1 SURGICAL APPROACH
    • Make a medial approach, following the mid-axis of the joint.
  • STEP 2 JOINT PREPARATION
    • Using a cup-cone configuration provides excellent bone exposure, construct stability, and metatarsophalangeal joint congruity.
  • STEP 3 POSITIONING OF ARTHRODESIS
    • Fix the toe in 5° to 10° of valgus and elevated 5 mm from the floor to achieve desired dorsiflexion.
  • STEP 4 APPLICATION OF IMPLANTS
    • Achieve a stable construct with a crossed lag screw and a dorsal locking plate (a hybrid construct).
  • STEP 5 CLOSURE
    • Perform a standard soft-tissue closure.
  • STEP 6 POSTOPERATIVE CARE
    • Allow weight-bearing as tolerated after two weeks and impact exercises only after bone healing has been shown on radiographs, which can take up to ten weeks.
  • RESULTS
    • Arthrodesis of the metatarsophalangeal joint in the hallux provides good results in terms of patient satisfaction and function, as demonstrated in many studies, most of them retrospective.IndicationsContraindicationsPitfalls & Challenges.