Chapter 111 - Forefoot Disorders Flashcards
Clinical hallmarks of 2nd MTP synovitis
pain, warmth, effusion of the second MTP joint
Pathophysiology behind 2nd MTP synovitis
synovitis stretches the capsuloligamentous structures around the MTP joint, leads to attenuation of the plantar plate and MTP instability
-> MTP hyperextension -> dorsal disloation -> predilection for hammer toe deformity
non-operative management of 2nt MTP synovitis
crossover taping
Budin splint
shoe modifications
10-12 weeks of tx
surgical treatment of 2nd MTP synovitis
no deformity: synovectomy
long second MTP: joint preserving osteotomy
FDL to EDL transfer if no long second toe
crossover toe deformity: EDB transfer
radiographic features of freiberg infraction
flattening of the metatarsal head (most commonly the 2nd) then collapse of the mt head
treatment for freiberg’s infraction
pre-collapse: non-weightbering in SCL with toe plate followed by several months in stiff soled shoe
surgical: dorsal closing wedge osteotomy (resects the collapsed dorsal diseased bone and brings less affected plantar cartilage to the articular surface)
lesser MTP deformities start with what structure?
plantar plate
Mallet toe
hyperflexion deformity at the DIP
MTP and PIP are neutral
flexible deformity: percutaneous FDL tenotomy (at its insertion on the base of the distal phalanx)
Fixed deformity (more common): distal condyle of the middle phalanx are resected, extensor tendon is repaired, and digit is pinned
Hammer toe
hyperextended MTP, flexed PIP, extended DIP
Most common lesser toe deformity
surgical tx: distal condylectomy of the proximal phalanx, then pin the toe. also need perc FDL tenotomy
Claw toe deformity
hyperextended MTP, hyperflexed PIP and DIP
Need three things:
1. address the MTP imbalance
- zplasty to the extensor tendon and MTP capsular release
2. distal oblique shortening osteotomy and/or FDL to EDL transfer
3. correction of hammer/mallet toe:
- proximal phalangeal condylectomy and FDL tenotomy
if there is also a crossover component, the injured collateral should be repaired with non-absorbable suture
types of bunionette deformity
1: enlarged 5th MT head, normal MT shaft and alignment
2. lateral bowing of the 5th MT
3. increased lateral bowing IMA >8
surgery for type I bunionette
lateral condylectomy with capsular reefing
if the head is huge you can do a distal MT chevron osteotomy
remember - a type one bunionette is enlarged 5th MT head, normal MT shaft and alignment
surgery for a type II/III bunionette
if IMA <12 - distal chevron medializing osteotomy - no need to pin or place hardware
if IMA >12 - oblique diaphyseal rotational osteotomy and screw
what procedure is NEVER the right answer for bunionette?
MT head resection
