A qualitative study of the functional outcomes following First Metatarsophalangeal Joint (MTPJ) arthrodesis based on a procedure focused questionnaire

Abstract

Hallux rigidus is the second most common condition to affect the first ray with an incidence of 2.5% in those above 50 years. Metatarsophalangeal Joint (MTPJ) arthrodesis remains the standard surgery. There are currently no patient-reported outcome measures or functional outcome measures specific to first MTPJ arthrodesis. Finding out what patients can and cannot do after surgery would help surgeons appropriately consent patients and manage expectations pre- and postsurgery. A pilot group of 15 patients postarthrodesis agreed on the suitability of the questions developed by the authors. As no further changes were made, a further 35 patients were recruited. Median age was 68 years, 78% were females, and 68% of patients were retired. Median follow-up was 64.5 months. Complete or almost complete pain relief was reported by 92% of patients. No major difficulty was reported by 97% of patients using ladders, 95% of patients driving, 90% of patients standing, 86% of patients wearing shoes without heels. Fifty-seven percent of patients reported extreme difficulty running and 48% of patients reported moderate or extreme difficulties wearing shoes with heels. None of the men reported difficulty with shoe wear without heels compared to 18% of women (p = .01). None of the men reported any difficulty in driving compared to 18% of women (p = .06). Difficulty in walking was reported in 44% of women compared to 9% of men (p = N/S). Our study is the first to reflect patients' own long term experiences following first MTPJ arthrodesis. Based on our study, following first MTPJ arthrodesis the majority of patients did not have trouble with pain, walking, standing, and driving. More than half of patients did not have trouble wearing shoes without heels; up to a third didn't have trouble wearing heels. More women experienced difficulty compared to men wearing shoes without heels, driving, and walking.