67 year old female with history of silastic great toe arthroplasty in 2001. Now with pain, deformity and
swelling. She has attempted conservative management with shoe modifications, carbon fiber insole,
activity modifications and medications without success.
She opted for removal of her silastic implant with revision to MTPJ arthrodesis. The procedure was
tolerated well and adjuvant hammertoe procedure with gastrocnemius recession was performed as
well.
The patient had 8 weeks of heel weight bearing cast immobilization with transition to a weight bearing
fracture boot until week 12 then transitioned to shoe wear.
At last follow-up one year postoperatively she rated her pain at 0/10 from 7/10 preoperatively and was
back to her activities of daily living

Preoperative standing A/P

Preoperative obliques

Preoperative standing lateral

Initial postoperative A/P

Initial postop oblique

Initial postop lateral

Postop year 1

Postop year 1

1. How would you have handled this?
2. Do you use silastic implants as an alternative to arthrodesis?
3. What other alternatives do you use to arthrodesis?

Reference:
Result of Arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length.
Myerson et al. Foot Ankle Int. April;21 (4) 2000. 297-306

https://www.aofas.org/PRC/meeting/Documents/firstmetatarsophalangealjoint.pdf