He walks with a limp and is unable to perform his usual recreational activities due to pain. In addition, he has pain at rest. Radiographs show dorsal osteophytes with advanced degenerative changes. An arthrodesis is indicated in this case. Although one may elect to perform a cheilectomy when there is mild to moderate degenerative changes present, good pain relief is not likely with more advanced changes and symptoms that this patient demonstrates.
Arthrodesis maintains stability and weightbearing of the first ray.
Many successful techniques have been described. I prefer to use a dorsal plate. The great toe should be placed in approximately 15 degrees of dorsiflexion and valgus. Many of these patients have little motion of the MTP joint preoperatively, and the arthrodesis places the toe in a more functional position. Individuals with a fused MTP joint can maintain a high level of activity and participate in a variety of sports.