Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Figure 1 Surgical technique. A: A dorsal midline approach provides adequate access to the joint; B: Extensor hallucis longus tendon is laterally retracted and adequate collateral ligament and capsule reflection provides excellent working space; C: A minimal flat cut is made to the head of the 1^st metatarsal utilizing an oscillating saw; D: A guidewire is inserted to the center of the 1^st metatarsal head; E and F: Hemispherical cup and cone reamers are used in order to remove the articular surfaces; G: Concave and convex surfaces of bleeding subchondral bone have been prepared with multiple perforations; H: Provisional fixation with two K- wires in the considered optimum position; I: The sagittal alignment is being checked intraoperatively using a flat tray simulating weight bearing. The 1^st metatarsophalangeal joint is positioned in a way that allows the pulp of the great toe to rest 5-10 mm above the flat surface; J: Final position of the plate.