Kevin,

I presume that first MTPJ fusions are performed on patients with significant
first MTPJ symptoms. I would hope most podiatrist would not fuse a joint if
it was asymptomatic. FHL, like most biomechanical anomalies which have yet
to be fully researched is likely a primary pathology in some cases and a
secondary pathology in others (as I would suspect is the position of the
stj). As Jeff has suggested , any patient receiving a first MTPJ fusion will
have likely already compensated for the discomfort and lack of first MTPJ
ROM. Sagittal Plane Facilitation suggests that an individual will compensate
according to their weakest link, hence the variation in biomechanical and
symptom presentation. Symptoms are not necessarily going to be at the First
MTPJ.  Whilst it is interesting to note what your esteemed surgical
colleagues see pre and post fusion of the first MTPJ on an extremely  small
number of patients it does not add to the understanding of primary or
secondary compensatory mechanisms related to functional hallux limitus.

Regards.

Graham

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