Big Toe Fusion Works and Adjacent Joint Wear Doesn't Seem to Matter

Adjacent joint arthritis is a big problem with ankle fusion, so why not with first MTP fusion?

 

The study: Radiographic changes vs. patient outcomes

 

In an exploratory study published last month, 77 patients were followed for nearly nine years. Radiographic arthritis progression was significant in all adjacent joints, most notably the interphalangeal joint (66 of the 77 cases). The tarsometatarsal, naviculocuneiform, and talonavicular joints also showed measurable degenerative changes. 

 

Despite these widespread radiographic findings, clinical outcomes remained strong: 91% of patients reported good or excellent satisfaction, with high functional scores across all measures. Joint wear didn't correlate with pain, alignment, or patient-reported outcomes.

 

Takeaway

 

MTP1 fusion delivers durable, excellent long-term results. The x-rays may look concerning over time, but patients largely don't feel it.

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Beyond NSAIDs: Could Proton-Pump Inhibitors (PPIs) Also Increase Nonunion Risk?

by Vince Vacketta, DPM

 

Orthopedic surgeons have long debated the effect of NSAIDs on bone healing. The spine literature, in particular, shows an increased risk of pseudarthrosis following prolonged or high-dose postoperative use. But NSAIDs may not be the only commonly prescribed medications that deserve our attention. 

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Retrospective review of hindfoot and ankle arthrodesis

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A new study suggests chronic PPI therapy may also negatively impact fusion healing following hindfoot and ankle arthrodesis.

 

Researchers performed their retrospective review of patients who underwent triple arthrodesis, ankle fusion, or isolated subtalar fusion. They compared patients taking PPIs at the time of surgery with matched controls to determine whether chronic PPI use affected fusion outcomes. 

 

PPI use linked to nearly double the risk of nonunion

 

• PPI use was associated with a significantly higher risk of nonunion –nearly twice that of nonusers – following hindfoot and ankle arthrodesis.

• The increased risk persisted after adjusting for demographic and medical comorbidities.

• These findings add to a growing body of evidence that medications affecting bone metabolism may influence arthrodesis success.

 

A different mechanism, a similar concern

 

Unlike NSAIDs, which impair prostaglandin-mediated bone healing, PPIs are thought to affect fusion through different mechanisms:

 

• Reduced calcium absorption

• Altered osteoclast function

• Impaired bone remodeling

• Potential suppression of osteogenesis

 

Although the mechanism differs, the clinical consequence may be similar: a less favorable biologic environment for fusion.

 

Adding PPIs to the preoperative risk assessment

 

NSAIDs have traditionally received the most attention regarding impaired bone healing, but this study suggests that PPIs may also warrant consideration in preoperative risk assessment. While additional prospective studies are needed to establish causation, chronic PPI use appears to be another potentially modifiable factor that surgeons should consider when optimizing patients for ankle and hindfoot fusion.

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Flatfoot Deformity Emerges as Strongest Predictor of Midfoot Arthritis (MA)

 

MA is the second most common site of arthritis in the foot. Inconsistent treatment approaches and limited academic focus create the opportunity for new avenues of research. Weight-bearing CT (WBCT) now offers a way to study associated risk factors for MA. 

 

WBCT analysis reveals MA risk factors

 

Researchers analyzed 606 cases (out of 1,316 total) from a single hospital’s WBCT database. They divided cases by the presence of MA and examined 25 potential risk factors. 

 

MA affected 56% to 58% of cases in both sexes. Five factors independently predicted MA:

 

• PCFD (flatfoot deformity) was the strongest link, with 6.6 times higher odds.

• Lesser toe deformities were associated with three times higher odds.

• Laterality was linked to 1.5 times higher odds.

• Age showed smaller, but significant effects.

• BMI showed smaller, but significant effects.

 

What this means for patient care

 

Clinicians can now flag patients with flatfoot or toe deformities as being higher risk for midfoot arthritis and may tailor treatment recommendations to etiology.