Bone peg arthrodesis of the first metatarsophalangeal joint.

In I952 Duncan McKeever described a method of arthrodesing this joint, by means of a screw inserted across the excised joint, the head of the screw lying under the proximal phalanx, the screw itself occupying the whole of the medulla of the metatarsal shaft. He appeared to be wholly satisfied with the results, but patients who have had this type of fusion have, on occasion, complained of pain over the screw head on walking, with loss of the efficient functioning of the long flexor of the toe, an all-important factor in\ securing a satisfactory gait. In addition, the presence of the metallic foreign body in the metatarsal shaft has on one occasion provoked a bony reaction with periosteal new bone formation, and cavitation of the metatarsal, accompanied by severe pain. These complications have necessitated removal of the screw, a task which is not always simple and which subjects the patient to a second operative procedure. The method of fusion to be described obviates these complications.