Irreducible Metatarsophalangeal Joint Dislocation of the Lesser Toes

2013 ◽  
Vol 103 (3) ◽  
pp. 236-240
Author(s):  
Honlok Lo ◽  
Ping-Cheng Liu ◽  
Po-Chih Shen ◽  
Shen-Kai Chen ◽  
Yuh-Min Cheng ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Metatarsophalangeal Joint ◽  
Recurrent Dislocation ◽  
Metatarsal Head ◽  
Activity Level ◽  
Rare Injury ◽  
First Metatarsophalangeal Joint ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Metatarsophalangeal Joints

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation. (J Am Podiatr Med Assoc 103(3): 236–240, 2013)

Plantar Dislocation of the Metatarsophalangeal Joint: Case Report

1994 ◽  
Vol 15 (8) ◽  
pp. 446-449 ◽  
Author(s):  
Kenneth A. Stephenson ◽  
Timothy L. Beck ◽  
E. Greer Richardson
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Kirschner Wire ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
The Third ◽  
Vehicle Accident ◽  
Plantar Aspect ◽  
Patient Reported ◽  
Metatarsophalangeal Joints

Dislocations of lesser metatarsophalangeal joints are rare and are almost always dorsal hyperextension injuries. The patient reported sustained plantar dislocations of the second and third metatarsophalangeal joints in a motor vehicle accident; the mechanism of injury was hyperflexion. Closed reduction was not possible, and at the time of open reduction, the extensor digitorum longus and brevis tendons to the third toe were trapped beneath the plantar aspect of the third metatarsal head. Once the tendons were retracted dorsomedially, the joint was easily reduced. Fixation with a Kirschner wire was necessary because of joint instability.

The Plantar Plate of the First Metatarsophalangeal Joint

2014 ◽  
Vol 7 (2) ◽  
pp. 108-112 ◽  
Author(s):  
Douglas E. Lucas ◽  
Terrence Philbin ◽  
Safet Hatic
Keyword(s):  
Sagittal Plane ◽  
Average Distance ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Cadaver Study ◽  
Joint Line ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Plantar Plate

The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures. The average distance of the plantar plate distal insertion from the joint line into the proximal phalanx was 0.33 mm. The plantar plate was inserted into the metatarsal head on average 17.29 mm proximal from the joint line. The proximal aspect of the sesamoid was 18.55 mm proximal to the distal attachment of the plantar plate to the phalanx. The distal aspect of the sesamoid averaged 4.69 mm away from the distal attachment into the proximal phalanx. The footprint of the distal plate insertion was on average 6.33 mm in length in the sagittal plane. The authors hope that these objective data measures can aid in the understanding and subsequent surgical repair of this important forefoot structure. Level of Evidence: Level V: Cadaver study

Integrity of the First Metatarsophalangeal Joint: A Biomechanical Analysis

1995 ◽  
Vol 16 (6) ◽  
pp. 357-362 ◽  
Author(s):  
David Prieskorn ◽  
Stan Graves ◽  
Michael Yen ◽  
Ray John ◽  
Schultz Randy
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Biomechanical Analysis ◽  
First Metatarsophalangeal Joint ◽  
Plantar Plate ◽  
Significant Damage ◽  
Different Types ◽  
Fresh Frozen

Five fresh-frozen cadaver feet obtained from traumatic amputations were tested during hyperdorsiflexion stress of the first metatarsophalangeal joint. Three different types of injury were observed: (1) rupture of the capsule proximal to the sesamoids, (2) rupture of the plantar plate distal to the sesamoids, and (3) rupture of the capsular structures medially, allowing a lateral swing of the sesamoids around the metatarsal head. Incomplete dislocation can be associated with significant damage to the plantar plate and other soft tissues of the foot.

Use of a Kirschner Wire for Distraction and Capsular Flaps in the Keller Interpositional Arthroplasty

2008 ◽  
Vol 98 (4) ◽  
pp. 326-329 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Fermin Viejo Tirado ◽  
Juan Carlos Prados Frutos ◽  
Kevin T. Jules
Keyword(s):  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
First Metatarsophalangeal Joint ◽  
Interpositional Arthroplasty

We describe a simplified capsular interpositional technique for the Keller bunionectomy that uses a Kirschner wire to interpose the capsule into the first metatarsophalangeal joint without requiring sutures. The capsule acts as a biologic spacer in the first metatarsophalangeal joint, allowing for fibrosis to fill the void created, with the Kirschner wire maintaining the distance between the metatarsal head and the stump of the proximal phalanx. This creation of a nonpainful pseudarthrosis prevents shortening of the hallux and retraction of the base of the proximal phalanx on the metatarsal head.

scholarly journals Structures at Risk with Plantar Approach Retrograde First Metatarsal Charcot Beam Screw Insertion

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
David Larson ◽  
Christopher Reb ◽  
Christopher Hyer ◽  
Patrick Bull ◽  
Jeffrey Weber
Keyword(s):  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Intramedullary Fixation ◽  
Easy Access ◽  
Low Grade ◽  
High Grade ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Plantar Plate ◽  
The Wire

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: The plantar approach for medial column retrograde intramedullary fixation of Charcot midfoot deformity allows for easy access to the ideal starting point on the metatarsal head and is supported by good clinical outcomes data. The primary argument against this approach is iatrogenic damage to the plantar structures of the metatarsophalangeal joint (MTP), which could cause tendon imbalances resulting in hallux malleus deformity. However, thus far, such complications have rarely been reported. Based on available literature, it is unclear what types of plantar structure injury occur and at what frequency. The purpose of this study was to describe plantar first metatarsophalangeal joint structure damage caused by plantar approach retrograde intramedullary medial column beam fixation. Methods: This was an IRB-exempt study. For each of 10 human cadaveric specimens, a 6.5 mm cannulated screw system was used for plantar approach retrograde medial column intramedullary fixation. This entailed using fluoroscopy to percutaneously localize a 2.8-millimeter (mm) guide wire to the center-center position on the first metatarsal head and then advanced it into the center of the medial cuneiform. A small sagittal plane skin incision was made around the wire and subcuticular tissue was bluntly divided. Next, a 4.8-mm cannulated drill was passed through a drill sleeve over the wire. Then, a countersink was used without a tissue protector. Finally, the 6.5-mm screw was inserted until it was recessed beneath subchondral bone. The specimens were then dissected to evaluate damage to the plantar structures of the 1st MTP joint. Damage to named structures was categorized as none, less than 50%, greater than 50%, and 100%. Results: The plantar plate was less than 50% damaged in all specimens. The flexor hallucis longus (FHL) tendon had less than 50% damage in 8 specimens. In one of two specimens with greater than 50% FHL damage, the torn portion of the tendon was tenodesed to the first metatarsal head by the screw (Figure). Although the medial flexor hallucis brevis (FHB) tendon was less than 50% damaged in 3 specimens and undamaged in the remainder, the medial sesamoid was less than 50% damaged in 8 specimens. In contrast, less than 50% damage occurred to the lateral FHB and lateral sesamoid in only 2 and 3 specimens, respectively. Additionally, some erosion of the plantar base of the proximal phalanx was observed in one specimen. Conclusion: The plantar structures of the hallux MTP are a tightly constrained system, which are violated during plantar approach retrograde intramedullary medial column fixation. No structures were completely transected and high-grade damage (greater than 50%) was infrequent, occurring in only two FHL tendons. Low-grade damage (less than 50%) was frequently observed to involved the FHL, medial sesamoid, and plantar plate. Based on the current findings, an FHL splitting or preserving approach is advisable to avoid high-grade damage if plantar approach is desired. A dorsal arthrotomy approach avoiding plantar structures may also be considered.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis

2021 ◽  
Vol 18 (14) ◽  
pp. 7520
Author(s):  
Hideki Ohashi ◽  
Keiichiro Nishida ◽  
Yoshihisa Nasu ◽  
Kenta Saiga ◽  
Ryuichi Nakahara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Roc Analysis ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Radiographic Measurement ◽  
Joint Dislocation ◽  
Severity Grading ◽  
Grade 3 ◽  
The Relationship ◽  
Mtp Joints

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

Multiplanar Correction of the Lesser Digital Deviation and Indirect Plantar Plate Rupture Repair Using a Braided Polyethylene Nylon Suture: A Technique Guide

2017 ◽  
Vol 10 (6) ◽  
pp. 551-554 ◽  
Author(s):  
Cody D. Blazek ◽  
Roberto A. Brandão ◽  
Jeffrey M. Manway ◽  
Patrick R. Burns
Keyword(s):  
Sagittal Plane ◽  
Digital Pathology ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Foot And Ankle ◽  
Dorsal Approach ◽  
Plantar Plate ◽  
Direct Repair ◽  
Nylon Suture ◽  
A New Technique

Forefoot and lesser digital pathology continues to be a challenging area of surgical correction for foot and ankle surgeons. Many techniques for the correction of digital deformities secondary to plantar plate rupture, regardless of planal dominance, have been described including direct repair and metatarsal shortening osteotomies for repair. The authors present a new technique for multiplanar correction of deformed lesser digits without direct repair of the plantar plate rupture utilizing a specialty suture. The technique utilizes a braided synthetic polyethylene Nylon suture, which has been traditionally used for open or arthroscopic shoulder labrum repair, for the stabilization of the lesser metatarsophalangeal joint. This novel technique guide for the correction of transverse and sagittal plane deformities of the digit at the metatarsophalangeal joint negates the need for a plantar incisional approach for plantar plate repair or metatarsal head osteotomy from a dorsal approach with augmented stabilization. Levels of Evidence: Level V: Expert opinion

scholarly journals Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Lei Zhang ◽  
Junqiu Wang ◽  
Jiaju Liu ◽  
Jiangqin Luo
Keyword(s):  
Hallux Valgus ◽  
Statistical Difference ◽  
Three Dimensional ◽  
Morphological Characteristics ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Type I ◽  
Sesamoid Bone ◽  
First Metatarsophalangeal Joint

The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (P<0.05); all a, b, c, d, and i have statistical difference between male and female (P<0.05). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.

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