Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

Hallux varus deformity most commonly occurs as a complication of bunion surgery. Surgical option depends on the underlying cause, flexibility of the deformity, and presence of osteoarthritis of the first metatarsophalangeal joint. Joint-preserving surgery including medial soft tissue release, metatarsal osteotomy, and tendon transfer can be considered in flexible deformity without degeneration of the first metatarsophalangeal joint. First metatarsophalangeal arthrodesis is indicated in cases of inflammatory arthritis, avascular necrosis, osteoarthritis, neuromuscular disorder, or failed previous hallux varus corrective surgery. The purpose of this technical note is to describe the technique of arthroscopic arthrodesis of the first metatarsophalangeal joint to correct hallux varus deformity. It has the potential advantages of less surgical trauma, preservation of blood supply, less postoperative pain, and better cosmetic results.
Technique Video Video 1 Arthroscopic arthrodesis of the first metatarsophalangeal joint in hallux varus of the right foot. The patient is in supine position with the legs spread. The abductor hallucis tendon and medial capsule of the first metatarsophalangeal joint is released via the proximal plantar medial incision. With the medial portal as the viewing portal and the dorsolateral portal as the working portal, the articular cartilage of the base of proximal phalanx and the metatarsal head is removed with an arthroscopic shaver and the subchondral bone is microfractured with an arthroscopic awl. Tourniquet is released to observe for bleeding from the microfracture holes. The first metatarsophalangeal joint is then reduced to 20° dorsiflexion and fixed with two 4.0 mm cannulated screws under fluoroscopic guide.