I couldn't agree more with Dr. Scartozzi's logic
and sentiment. I simply fail to understand the
rationale that supports fusing a salvageable 1st
MTP. Proponents of 1st MTP fusion claim
excellent functional results post operatively.
Really? What does that mean to a healthy, young,
active individual who wants to retain the same
activity level post operatively as they enjoyed
pre-operatively? When you have a pre-operative
functional 1st MTP, a surgeon's goal should be
to retain joint motion, even increase it when
possible, not eliminate it.
In this case, while the PASA and IM angles are
significantly elevated, a clear joint space
exists which indicates cartilage presence, hence
the ability to maintain full joint
unctionality...therefore, its reconstruction and
alignment is what its indicated, not its
elimination, ESPECIALLY in a young, active
patient. Unless there is a co-morbid scenario,
or post operative compliance issue perceived by
the surgeon pre-operatively that would
contraindicate the performance of a basal 1st
ray IM angle correction, I see no rationale
justifying fusing a healthy 1st MTP.
In my humble opinion, with respect to the
surgical management of hallux abducto valgus
deformity, our profession and our patients would
be best served by its surgeons returning to 1st
ray basics, rather than incorporating needless
salvage procedures originally designed with its
primary goal of eliminating arthritic joint pain
in those patients incapable of joint function
preservation. One can talk all day about
reduction of MTP retrograde forces and IM angles
via fusion...that's all well and good...but why
not simply address the deformity where it lays
while preserving joint function? What sense does
it make to eliminate the 1st MTP ROM? How can
one compare 1st ray functionality of fusion vs
joint preservation? That's simply a cop out from
surgeons who for whatever reason, don't want to
manage the added issues associated with
aggressive, proximally based 1st ray correction,
or don't have a comfort level performing them,
or who have experienced poor outcomes in the
past.
If the 1st and 2nd concerns are the issue, then
recheck your technique AND have an experienced
surgeon who has enjoyed past success accompany
you in the OR, or refer the patient to that
colleague. Anything less, from my perspective,
is a disservice to your patients.
Barry Mullen, DPM, Hackettstown, NJ,
yazy630@aol.com
