Purpose of the study: The choice between preservation of the joint shape and straight cuts for arthrodesis of the metatarsophalangeal joint (MPJ) remains a subject of debate.

Material and methods: Sixty patients (74 feet), mean age 67 years, underwent fusion of the first MPJ. There were 52 women and 8 men. Follow-up was 38 months. The operation was performed with a tourniquet and locore-gional anesthesia. The procedure consisted in resection of the remaining cartilage and subchondral bone with preservation of the joint shape. Axial reduction was achieved with back-and-forth pinning the compression stapling on the dorsal aspect. The patient wore a postoperative boot for six weeks.

Results: mean time to healing was 15 weeks (rate of fusion 94.6%). The AOFAS score improved from 29.2/100 preoperatively to 77.1/100 postoperatively. 83% of patient resumed their normal activities. The mean M1P1 angle improved from 34.7° preoperatively to 23.8° postoperatively. Dorsal flexion was 26.8° postoperatively. 79.7% of patients were completely satisfied and 13.5% partially satisfied.

Conclusion: Arthrodeis of the first MPJ is a good technique for selected patients. Use of two dorsal staples for compression is more economical and gives the same rate of fusion as more sophisticated methods. Preservation of the joint shape has no influence on the rate of fusion. There is no mid-term impact on the interphalaneal joint.

Purpose of the study: When it became popular in the 1980s, the wedge osteotomy proposed by Kenneth John-son of the Mayo Clinic was not advocated for patients over 50 years of age. We wanted to known whether it could work in patients over 60.

Material and methods: Between January 1987 and December 1988, 62 patients underwent surgery for moderate hallux valgus. Wedge osteotomy was performed in all cases associated with phalangeal osteotomy and lateral release of the metatarsophalangeal joint (MTJ). Mean patient age was 60.2 years. Patients were followed ten years on average.

Results: Thirty-nine patients (48 feet) were reviewed. Radiological recurrence was noted in nine feet. The average hallux valgus M1P1 angle was 35° preoperatively and 9.8° postoperatively. The average M1M2 angle was 11.4° preoperatively and 4.6° postoperatively. Joint motion was good for the first MPJ, with average 51° dorsiflexion, and 14° plantar flexion. These results were obtained despite the opinion that wedge osteotomy stiffens the MTJ after 50 years. Patient satisfaction was very good, especially for shoe wearing, the esthetic result, and pain relief. Most recurrences involved non-correction of the distal articular angle, an observation which would be rather surprising in older patients. There were no cases of necrosis of the metatarsal head and the degenerative changes observed radiographically had little clinical impact.

Conclusion: This series has enabled us to conclude that the risk of wedge osteotomy of the metatarsal is not greater after the age of 60 years and that it provides very satisfactory long-term results.