The ability to wear high heeled footwear after first metatarsophalangeal joint fusion
P. D'sa, S. Vaidhyanathaswamy, J. Manara, K. Hariharan
Background: Fusion is a well entrenched treatment modality for symptomatic 1stMTP joint arthritis. It has been customary to advice female patients that they would be unable to wear high-heeled footwear post surgery due to lack of dorsiflexion at the 1stMTPJ.
Objectives: To determine the proportion of patients who could continue wearing high-heels after 1stMTPJ fusion and whether they required a change in the size of their footwear.
Methods: A retrospective review of 50 female patients who have had an isolated 1stMTPJ fusion between 2004 and 2016 was undertaken with a follow-up telephone survey which included questions on ability to wear high-heels pre and post-operatively, duration and height of heels they could wear.
Results: This study included 50 female patients (62 feet) with mean age of 63(43-78) years with a mean follow up of 6.5(2.5-14) years from surgery. Of 42 patients who wore high-heels pre-surgery, 26(62%) continued wearing them. Majority of them (n=23) were able to wear the same height heels. 88% patients were able to wear heel heights of 1.5'' or higher and wear them for 30 minutes to 8hours (Mean=3hrs 15mins). 20 patients (40%) required different sized footwear following surgery. None of the patients wearing high-heels returned to clinic with midfoot/hindfoot symptoms, one returned for IPJ symptoms.
Conclusions: This pilot study has important implications for information given to patients during consent for this operation. It may be that in many cases functional change in neighbouring joints compensates for the loss of movement at the 1stMTPJ although it was outside the scope of this study to determine how this occurred. Our results have shown that many patients continue to wear high-heels following 1st MTPJ fusion with minimal symptoms in neighbouring joints. The most important factor appears to be the ability of the patient to wear high-heels preoperatively.
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