Die Arthrodese des Tarsometatarsal-I-Gelenks mit einer plantaren Zuggurtungsosteosynthese

Objective

Treatment of hallux valgus in patients with a pathology of the first metatarsocuneiform (MC) joint by a fusion of the first MC fixed by a plantar plate. The plantar plate has biomechanical advantages and has good soft tissue coverage by the M.?abductor hallucis.

Indications

Instability or degenerative arthritis of the first MC joint in patients with hallux valgus.

Contraindications

Short first metatarsal.

Surgical technique

Bone-saving resection of the first MC joint. Arthrodesis using a compression screw and a plantar interlocking plate. Distal soft tissue procedure and resection of the exostosis.

Postoperative management

For 6?weeks, a long sole, post-operative shoe with weight bearing as pain allows. Mobilization of the first metatarsophalangeal joint when the wound healing is assured. Full weight bearing after 6?C8?weeks in a normal shoe, when the bone healing is completed on the x-rays. No sports with high demands on the foot for 12?weeks. Orthotics only in cases with persisted pain or associated pathology.

Results

In a case control study including 72?patients, a significantly lower rate of nonunion and soft tissue problems, compared to dorsal or medial plate positioning, was observed.