First metatarsophalangeal arthrodesis for severe bone loss.

Severe bone loss of the first metatarsal is a significant problem in revisional surgery of the first metatarsophalangeal joint either after failed hallux valgus surgery or failed primary arthrodesis. A short first ray leads to pathologic biomechanics of the forefoot, which is treated with interpositional bone block arthrodesis. A ball-in-socket preparation performed with cup-in-cone reamers is the preferred method for modeling of the bone block. An autologous iliac crest bone graft reveals good results by bony integration. Bone block arthrodesis represents a feasible treatment for severe bone loss, leading to good clinical results at midterm follow-up.