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Interpositional Arthroplasty of the Great Toe Metatarsophalangeal Joint Using Autogenous Fascia Lata for Advanced Hallux Rigidus

A technique using interpositional autogenous fascia lata graft after complete resection of the joint for primarily advanced hallux rigidus has provided pain relief, flexibility, allowed the use of various dress shoe heel heights, maintained joint alignment, and been durable. Toe flexion power is decreased and some degree of transfer metatarsal callusing has occurred, but patient satisfaction has been high. It appears to be an alternative to fusion in selected patients. Between 2005 and 2010, 13 patients, 15 feet, (11 females, 2 males), aged 36 to 81 years (mean age, 65 y) underwent interpositional arthroplasty with fascia lata graft for primarily advanced hallux rigidus with a mean follow-up of 22 months. AOFAS hallux score averaged 4 postoperatively. Pain scores averaged 1/10 postoperatively. Dorsiflexion averaged 9 degrees preoperatively and 39 degrees postoperatively; plantar flexion 10 degrees preoperatively and 15 degrees postoperatively. Most importantly for many women, over 80% could now wear what they considered satisfactory fashion shoes, where as none could do so preoperatively. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.