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Complex First Metatarsophalangeal Arthrodesis for Revision of Failed First Metatarsophalangeal Procedures
Revision fusion of the first metatarsophalangeal (MTP) joint is typically indicated for painful nonunion, improper first ray position after primary fusion (hallux varus, excessive valgus, plantar flexion, dorsiflexion, and pronation), and shortening of the first ray after primary fusion leading to transfer metatarsalgia. The incidence of nonunion after nonrheumatoid primary first MTP arthrodesis using modern fixation and joint preparation techniques is 5.4%. However, only about one third of those nonunions are painful (1.8% total incidence). The total incidence of malunion is reported to be 6.1%, of which 87% are dorsal malunion.