Metatarsophalangeal joint arthrodesis, as a corrective measure for severe hallux valgus deformity, has a long history and remains in use today. Indications for the first metatarsophalangeal joint arthrodesis include severe hallux valgus deformity, revision surgery for recurrent hallux valgus, hallux deformity in rheumatoid arthritis, severe hallux rigidus, joint infection, primary or secondary osteoarthritis, hallux valgus deformity due to neuromuscular disorders, and severe gouty arthritis. Innovative research continues to emerge in biomechanics and materials science related to the first metatarsophalangeal joint arthrodesis. Surgical fixation options are diverse and evolving, encompassing traditional screws and plates alongside novel intramedullary fixation systems and shape-memory alloy implants. Biomechanical studies, gait analysis research, and clinical trials consistently demonstrate minimal postoperative impact on gait and no significant impairment of functional mobility. When performed with proper technique, complications are rare. The first metatarsophalangeal joint arthrodesis is an effective and reliable method for treating severe hallux valgus deformity.
Objective To evaluate the effectiveness of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture. Methods From October 2004 to June 2007, 32 patients (35 feet) with chronic Achilles tendon rupture were treated, including 21 males (22 feet) and 11 females (13 feet) and aging 32-85 years. The disease course was 4-132 days. There were 29 patients with hoofl ike movements history and 3 patients withoutobvious inducement. The result of Thompson test was positive in 31 cases (33 feet). The score was 56.09 ± 7.25 according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system (AOFAS). MRI indicated that the gap of the chronic Achilles tendon rupture was 0.5-5.0 cm. Medial foot incision associated with medial heel incision or only medial heel incision was made to harvest flexor hallucis longus tendon. The tendon should be 3 cm longer than the end of the Achilles tendon, then fix the tendon to the calcaneus. Results Wound dehiscence occurred and wound healed after dressing change in 1 case; wound healed by first intention in other patients. Thirty-two patients were followed up for 12-32 months (mean 19.4 months). The AOFAS score was 94.22 ± 4.63, showing statistically significant difference when compared with that before operation (P lt; 0.01). The results were excellent in 28 cases, good in 3 cases and fair in 1 case. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury and lateral plantar nerve injury occurred. Conclusion Flexor hallucis longus tendon transfer offers a desirable outcome in operative recovery, tendon fixation and compl ications.