Why do you think that radiographic alignment was not correlated with arthritis progression, metatarsalgia, or patient-reported outcome measures? Was it because in this study the vast majority of MTP joint fusions were in an acceptable position? Were you and your co-authors surprised that alignment did not correlate with arthritis progression?

Yeah, I would answer both questions with yes.

The majority of patients in our cohort had their fusions positioned within a clinically acceptable range.

However, we also had some clear outliers.

And even in those cases, we found no consistent association with arthritis progression clinical parameters or prompts.

But I also believe that the foot has a remarkable ability to compensate for small differences in alignment.

We see this in everyday clinical practice, where some patients have surprisingly good function in their foot despite marked forefoot deformities.

What do you tell patients with end-stage hallux rigidus who do not wish to have a fusion and request a first MTP joint replacement?