Good afternoon, today I'm presenting our study on the influence of first metatarsal phalangeal joint degenerative changes on the functional outcome following Hallux Valgus corrective surgery. None of the authors have any disclosures related to the study. In last year's meeting, we presented our study looking at the prevalence of arthritis in patients with Hallux Valgus undergoing surgery without clinical symptoms of arthritic changes. In this study, we divided the metatarsal phalangeal joints into six zones. Zone one through four involved the pistol aspect of the articular surface, while zones five and six represented the metatarsal sesamoid articulation on the plantar aspect of the metatarsal head. We divided the arthritic grades found intraoperatively on direct visualization of the articular cartilage into three grades. Grade zero had normal visual cartilage, grade one had degenerative changes but without exposed bone, and grade two had visually exposed bone at the metatarsal head articulation. We looked at 200 feet and 196 patients through a myriad of different surgical procedures. The intraoperative findings demonstrated a high proportion of arthritic changes involving the sesamoid metatarsal articulation. In fact, 87% of patients had some arthritic changes at the sesamoid metatarsal head articulation, which was far more than we had clinically expected, and many of these had grade two arthritic involvement in this area. When we looked at predictors of arthritis, we found that patients with more severe deformities with intermetatarsal angles of greater than 14 degrees had a higher degree of more severe arthritis, and patients with more advanced age also correlated with more severe arthritic scores. But the question came up, does this make any difference to outcomes? Does the presence of intraoperative findings of degenerative arthritis result in worse outcomes following palatomelgus corrective surgery? This study today represents the second stage of our evaluation. This was a prospective IRB-approved study with appropriate consent from all patients who are now contacted two years after their surgery and who underwent patient functional outcome evaluations, including foot manculability measure, activity of daily living, and sport subscale scores, visual analog scale pain scores, and SF12 physical and mental health evaluation. Statistical analysis was undertaken by Spearman correlations, as well as one-way ANOVA performed to determine the relationship between the arthritic changes and outcome scores. We were able to get a hold of 141 patients who completed patient-reported outcome scores at two years and who had all their initial findings available to us. Mean fallout time was 25 and a half months, with a minimum time at two years. Ninety percent of patients were female. When we looked at the overall results, there was a statistically significant improvement in outcomes comparing pre- to post-operative findings for activity of daily living and sports, as well as improvement in pain scores in all patients. When we looked specifically at zone 5 and 6, the sesamoid metatarsal articulation, and we created a scoring system specifically for this, looking at their scores of each zone, 0 to 2, and plotted each one out with a minimum of zero points and a maximum of four points for any one patient. When we looked at the results to see if there was any difference, whether they have arthritis, starting off midway with half the patients having a score of less than 2 and half the patients having a score of more than 2, when we looked at their pre-operative findings, when we looked at their final scoring results of all the reported analysis, and when we looked at the change or the improvement from pre-op to post-op, there was no difference between the patients for those who had a lesser arthritic score and a more arthritic score. So we looked at it again with a minimum of three out of four, and again, no statistically significant difference between the groups. And even if we only looked at patients with four out of four scores and compared those to all patients with less than four out of four scores, once again, there was no statistically significant difference in any parameter as comparing these two groups. The only area that did make a difference was that patients who had arthritic changes in zone 2 had a positive correlation with their foot and ankle ability measure sports score. We hypothesized that this was because of more mechanical stress in the dorsolateral aspects of the metatarsal head while doing sports events. But in general, patients with more arthritic changes at the metatarsal head area, more so than at the sesamoid area, correlated with a greater improvement in their pain scores from pre-operative to post-operatively. We hypothesized that this was because of the correction or the congruency of the joint decreasing the arthritic pain following correction of their deformities. So in conclusion, at two years follow-up, the presence of clinically insignificant but intraoperatively evident degenerative changes at the first metatarsal head, particularly at the sesamoid metatarsal articulation, does not adversely affect the outcome or improvement in pain or functional ability following correction of Haleck's valve deformity. It is yet to be seen if this lack of effect will stand up with longer-term follow-up of these patients' corrections, which will be the next stage in our outcome study. Thank you for your attention.

degenerative changes

first metatarsal phalangeal joint

functional outcome

corrective surgery

Hallux Valgus