Indications for and Technique of First Metatarsophalangeal Joint Arthroscopy

Abstract

Background: Arthroscopy of the great toe metatarsophalangeal joint has been used for a variety of indications, ranging from synovitis to osteochondral defects. The purpose of the present study was to define the indications for arthroscopy, assess its efficacy, and demonstrate the limitations of this procedure. Methods: Hallux metatarsophalangeal joint arthroscopy was used in 20 patients (25 feet). Indications included degenerative disease with early osteophytosis, chondromalacia, osteochondral defects, loose bodies, arthrofibrosis, synovitis, gouty arthritis, first metatarsophalangeal joint pain with no obvious findings clinically and radiographically in young adults, and intra-articular fracture of the first metatarsophalangeal joint. All patients had a minimal followup of 2 years and were evaluated clinically and radiographically. Results: Arthroscopic surgery resulted in pain free first metatarsophalangeal joints in 95% (19 of 20 patients). Patients with degenerative disease had a pain-free joint for a minimum of 2 years. The patients with gouty arthritis and intra-articular fracture had good functional outcomes. Arthroscopy also helped in identifying the pathology in painful joints with no obvious radiographic features that included conditions such as ‘meniscoid’ and other impingement lesions. Conclusion: Arthroscopy of the first metatarsophalangeal joint is not suitable for patients with extensive degenerative changes and large osteophytes and those that require cheilectomy or arthrodesis. Arthroscopic management of certain painful hallucal metatarsophalangeal joints is a specialized technique, which if performed for the right indications, gives a favorable outcome with minimal complications.