Our Summary

This research paper looks at the effectiveness and safety of a surgical procedure called arthroscopy on the first metatarsophalangeal (MTP) joint, or in simpler terms, the big toe joint. The researchers reviewed 36 cases where patients underwent this procedure over six years.

The most common reason for this surgery was a condition called hallux rigidus, which is a type of arthritis in the big toe. There were also patients who had the surgery due to a non-healing fracture in a specific bone in the foot (the sesamoid bone), a defect in the first metatarsal head (another foot bone), or due to complications from a previous surgery for a bunion (hallux valgus).

After the surgery, patients were asked about their satisfaction with the procedure, and more than 88% were satisfied or very satisfied. More than 90% said they would have the procedure again if needed. The satisfaction rate was particularly high (90.4%) for patients with early stages of hallux rigidus. Also, all patients with the non-healing sesamoid bone fracture were very satisfied, and those who were athletes were able to return to their sports activities at the same or even improved level after the surgery.

There were some complications: four cases (11.1%) of accidental injury to nerves in the big toe, with one case leading to permanent sensory impairment.

Overall, the study concludes that arthroscopy of the first MTP joint is a safe and effective procedure. The researchers suggest that it should be considered as the first choice of surgical therapy for the initial stages of hallux rigidus and sesamoid bone pathology.

FAQs

  1. What is the most common reason for undergoing arthroscopy on the first metatarsophalangeal joint?
  2. What were the satisfaction rates among patients who underwent this procedure, and would they have the procedure again if needed?
  3. Were there any complications reported in the study from this type of surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about arthroscopy is to follow the post-operative care instructions carefully, including keeping the surgical site clean and dry, taking prescribed medications as directed, attending follow-up appointments, and participating in physical therapy as recommended to optimize recovery and outcomes. It’s also important to communicate any unusual symptoms or concerns with the doctor promptly.

Suitable For

Patients who are typically recommended arthroscopy of the first MTP joint include those with hallux rigidus, non-healing sesamoid bone fractures, defects in the first metatarsal head, and complications from previous bunion surgeries. Additionally, athletes who require foot surgery may also benefit from this procedure, as they were able to return to sports activities at the same or improved level after surgery. However, it is important to note that there were some complications, such as accidental nerve injuries, so patients should discuss the risks and benefits with their healthcare provider before undergoing arthroscopy.

Timeline

Before arthroscopy:

  1. Patient experiences pain, stiffness, and limited range of motion in the big toe joint.
  2. Patient may try conservative treatments such as rest, ice, medication, physical therapy, or injections.
  3. If conservative treatments are not effective, patient may be recommended for arthroscopy.

After arthroscopy:

  1. Patient undergoes the arthroscopic procedure on the first MTP joint.
  2. Patient experiences post-operative pain and swelling, and is instructed to rest and elevate the foot.
  3. Patient undergoes physical therapy to regain strength and range of motion in the toe.
  4. Patient reports high satisfaction with the surgery, with over 88% being satisfied or very satisfied.
  5. Patient may return to sports activities at the same or improved level.
  6. Some patients may experience complications such as nerve injury, although this is rare.
  7. Overall, the surgery is deemed safe and effective for conditions such as hallux rigidus and sesamoid bone pathology.

What to Ask Your Doctor

Some questions a patient should ask their doctor about arthroscopy include:

  1. What is the specific reason for recommending arthroscopy for my big toe joint?
  2. What are the potential risks and complications associated with this procedure?
  3. How long is the recovery period after arthroscopy, and what can I expect in terms of pain and mobility during this time?
  4. Are there any alternative treatments or therapies that I should consider before opting for arthroscopy?
  5. How many arthroscopy procedures have you performed on the first MTP joint, and what is your success rate?
  6. Will I need physical therapy or rehabilitation after the surgery, and if so, what will that involve?
  7. How long will the effects of arthroscopy last, and are there any long-term considerations I should be aware of?
  8. Are there any specific lifestyle changes or modifications I should make post-surgery to support my recovery and prevent future issues?
  9. What should I do if I experience any unexpected symptoms or complications after the procedure?
  10. Can you provide me with any additional resources or information to help me better understand the arthroscopy process and its potential outcomes?

Reference

Authors: Levaj I, Knežević I, Dimnjaković D, Smoljanović T, Bojanić I. Journal: Acta Chir Orthop Traumatol Cech. 2021;88(3):211-216. PMID: 34228617