First metatarsophalangeal joint fusion is a successful pro cedure for the treatment of rheumatoid forefoot problems, severe osteoarthritis of that joint, and failed first ray sur geries. We have identified three patients with fracture of the first metatarsal after fusion with Steinmann pins. Pen etration of the plantar and/or plantar medial cortex of these pins should be avoided. If penetration occurs, we recommend casting after pin removal.
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