Operative indications and cases to be wary of

Painful arthritis of First MTP. This is a dependable procedure for most age groups and activity requirements. There will probably be a restiction in ability to wear significant heels. If this is an issue it is usually with female patients. Consider also Debridement/Moberg procedure. There are no absolutes on when to fuse. Generally in terms of importance in decision making symptoms should outweigh radiographic appearance. Know your patient and their requirements. For older and non deformed cases a replacement may be an alternative to fusion. Always have as a back up some type of dorsal plating system, should bone quality not allow adequate compression/fixation with crossed screws. If the Intermetatarsal angle between 1st and 2nd metatarsals is significantly increased this can corrected acutely as well .The technique involves performing a generous lateral release, directly opposing the first metatarsal back towards the second, using a "bowstring" effect from the tight ehl tendons to hold the reduced position. This is best fixed with a dorsal plate such as the Wright MTP fusion system. If this element is not corrected at the time of operation there is a tendency for spontaeous reduction in the IM angle over ensuing months.