Encouraging Results Seen with Early Ambulation After First Metatarsophalangeal Joint Fusion with Locking Plate
Pain and stiffness of the first metatarsophalangeal joint (the "big toe" joint where it meets the foot) is fairly common and can be caused my any number of conditions, such as rheumatoid arthritis, failed bunion surgery, or cerebral palsy, to name a few. To reduce the pain and disability, surgeons fuse the joint with a procedure called arthodesis. They can do this procedure with a variety of tools. They can use wires, pins, screws, even metal plates to stabilize the bones. Whatever technique they use for the surgery, care after the surgery will play a large role in how effective the procedure will be. Currently, the routines for post-operative ambulation (getting up and about after surgery) vary greatly.

There are reports surgeons requesting their patients get up walking, with early weight-bearing, usually wearing a special shoe or cast. However, there are no reports on the early ambulation of patients who had this type of fusion using compression screws and locking plates. The authors of this article describe two patients who were ambulated right after surgery.

The first patient, a 59-year-old female had undergone a bunionectomy earlier but has since experienced severe pain to the first toe joint. X-rays showed narrowing space in the joint and degeneration of the joint. A surgeon performed the arthodesis using a compression screw and locking plate and the patient began waling immediately after surgery, while wearing a specially fitted post-operative shoe. Seven weeks later, the patient was able to wear regular shoes and had no complaints of pain while walking.

The second patient, a 53-year-old male was complaining of pain in the toe joint, which on an x-ray showed degeneration and narrowing of the joint space. He had been treated without surgery but now wanted to have surgery to relieve the pain and discomfort. The surgeon used the compression screw and locking plate, as with the first patient. After surgery, the patient also was walking with a specially fitted shoe. On follow-up, eight weeks later, the patient was wearing normal shoes and reported that he had no pain.

The locking plate used by the surgeons has advantages over the standard plates that were being used. The locking plates, combined with the screws made a stable enough fixation for patients to ambulate quickly. Early ambulation has many benefits that reduce the risks of complications associated with surgery, such as blood clots.

In conclusion, the authors found that using the compression screws and locking plates, and encouraging early ambulation with the use of special shoes provided encouraging results.
Robert M. Greenhagen, DPM, et al. Immediate Ambulation after a First Metatarsophalangeal Joint Fusion Using a Locking Plate: Technique and case reports. In The Foot and Ankle Online Journal. April 2010. Vol. 3. No. 4.