Evaluating Interphalangeal Joint Risk After Hallux MTP Arthrodesis
One debate that arises when discussing first metatarsophalangeal (MTP) joint arthrodesis is whether this procedure might hasten degeneration of the adjacent hallux interphalangeal (IP) joint. While biomechanical paradigms suggest an impact from potential stress transfer, long-term empirical data has thus far been limited.
A recent study in Foot and Ankle International utilizing a robust national commercial insurance database (PearlDiver) could offer critical insight into this issue. Researchers identified over 15,000 patients who underwent first MTP joint fusion and followed them for a full decade to assess the incidence of subsequent IP joint fusion.1 Only 166 patients—just over 1%—required IP joint fusion within 10 years of their original MTP arthrodesis. The mean time between procedures was 4 years. Given that procedural codes in the database lacked laterality, the true ipsilateral risk may actually be lower, as a portion of those IP fusions could have been performed on the contralateral foot.1
These findings could provide some level of reassurance to both patients and surgeons. The data suggest that the vast majority of patients maintain stable hallux IP joint function for at least 10 years following MTP fusion, with very few progressing to further surgery. However, one must consider that although the vast majority of patients studied did not go on to IP joint fusion, the study did not specifically evaluate for findings of joint degeneration or biomechanical metrics to assess true IP joint function. However, this data provides interesting insight over a long follow-up period that could begin to shed more light on this clinical question.
Reference
1. Alkaramany E, Rodriguez-Materon S, Dai AZ, Mansur NSB, Guyton GP. Rate of subsequent hallux interphalangeal joint fusion After first metatarsophalangeal fusion: A national database study with verified continued patient enrollment. Foot Ankle Int. 2025;46(6):629-632. doi:10.1177/10711007251328656
Diabetic Foot Fracture Treatment: New Insights from 13 Years of National Data
Managing foot fractures in patients with diabetes remains a high-stakes clinical challenge. While complications after tibial and malleolar fractures are more studied, data on the outcomes distal to the ankle—particularly in patients with diabetes versus those without—has remained limited. A new retrospective analysis now helps fill that gap.
Researchers in a recent article in-press in the Journal of Foot and Ankle Surgery utilized 13 years of data from a large claims database to assess outcomes of open and closed treatment of multiple foot fracture locations, followed for at least one year. The study population included over 108,000 patients with diabetes and more than 302,000 without.1
They found that patients with diabetes experienced significantly higher rates of most complications, regardless of the bone fractured or open versus closed treatment. Among the most striking findings1:
• Medical complications (eg, acute kidney injury, myocardial infarction, deep vein thrombosis (DVT)) were 5–15 times more common in patients with diabetes.
• Surgical complications, including reoperation, delayed or non-union, surgical site infection (SSI), wound disruption, and amputation, were consistently more prevalent in the diabetic cohort.
• Patients with diabetes and forefoot fractures showed the highest odds ratios for SSI and wound breakdown, possibly due to neuropathy and plantar pressure.
While there were a few exceptions—such as no statistically significant difference in talar delayed union or DVT rates in cuneiform fractures—the overall burden of complications was significantly elevated across all bone groups for those with diabetes.1
These findings support a more cautious and tailored approach when treating diabetic foot fractures. When pursuing any treatment course, optimization of comorbidities, careful technique, and vigilant postoperative monitoring are essential.
Reference
1. Nandakumar D, Conover BM, Johnson MJ, Raspovic KM, Wukich DK. Outcomes of open or closed treatment of foot fractures: A database study comparing patients with and without diabetes. J Foot Ankle Surg. 2025:S1067-2516(25)00142-5. Epub ahead
of print.
