RE: 1st MPJ Implant or Fusion and Running (Doug
Milch, DPM)
From: Multiple Responses
Ten years ago, I operated on one of the most
famous soccer players in the world (from
England. He had a prior surgery on his 1st MTP
for hallux rigidus. He was 36 years old. I did
an arthrodesis and much to my surprise, he
played one more year of professional soccer. I
have and continue to tell all people who have a
fusion that it is unlikely that they will ever
be able to run long distance, but they can try.
With any other operation for hallux rigidus in
that age group and with the symptoms you
describe, the chances of running post-op are
less than with a fusion.
Lowell Scott Weil, Sr. DPM
Weil Foot & Ankle Institute
I have never been an advocate of fusing joints
when other options are available. Given the
difficulty and the patient literally stuck with
the results, there are always better options. I
had performed many conservative approaches to
this condition with wonderful lasting results;
in other words, prolonging the need for joint
replacement or fusion at any and all costs.
Performing an arthrotomy with follow up orthotic
made to allow first ray plantarflex by
supporting the 1st- met cuneiform joint has been
very successful.
Jeffrey Trantalis, DPM
Deerfield Beach, FL
In my practice, I have been successful in
treating the younger/more athletic patients with
fusion because of its long term predictability
and stability. I reserve implants for a slightly
older and less active group of patients. I
would not hesitate to use an implant on a 55
year old, however, would be cautious on its use
with a runner.
That being said, there is no guarantee that post
fusion that a person will get back to running
painlessly. I personally think that treatment
for hallux rigidus is tough with no absolute
formula for success. Often the surgical decision
is based on experience with people of different
lifestyle needs, success with prior procedures
and ultimately a gut feeling.
Lowell Weil, Jr., DPM, MBA
Weil Foot & Ankle Institute
In my hands, a properly set 1st MTPJ arthrodesis
is extremely functional and well tolerated by
runners. I have never tried an implant
arthroplasty on a runner but In my opinion
silicone would break down too quickly under the
stresses of regular running and with metal you
are risking impaction through the distal phalanx
or loosening of either component. Once a good
arthrodeis heals, the patient’s treatment is
complete. With an implant under heavy activity,
you should expect a revision.
Marc Garfield, DPM
Newport News, VA
Be very cautious about post-operative
expectations in runners after 1st MPJ implant
surgery. My chief concern would not be a
problematic or symptomatic or painful 1st MPJ,
but rather transfer or sub 2nd metatarsalgia or
(pre-dislocation 2nd hammertoe syndrome) as the
1st MPJ becomes much less stable after any
implantation surgery and weight bearing
pressures and forces become higher under the 2nd
metatarsal head and the 2nd phalangeal joint.
Also be careful to avoid, if possible shortening
of the great toe, especially if this patient has
a relatively long 2nd metatarsal or 2nd toe.
Often in these patients, a 1st MPJ fusion is the
better overall procedure, except that the 1st
MPJ will no longer bend.
Keith Gurnick, DPM
Los Angeles, CA
