An Emerging Option For Treating Severely Subluxed Lesser MPJ Deformities In Seniors

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Author(s): 
Michael Tritto, DPM

   Once you are satisfied with the position, remove the wire and insert the absorbable fixation. With the Trim-It pin, you can retrograde it out the distal toe and then drive the pin from the distal toe, crossing the distal interphalangeal and proximal interphalangeal joints. Drive the absorbable pin so you can see it exiting the base of the phalanx, align it with the hole you already drilled in the metatarsal head and drive the pin into the metatarsal about 2 to 2.5 cm. Once the pin is across the MPJ, cut the pin flush with the tip of the toe and tamp the distal end so it is under the skin. The OrthoSorb pin is not long enough or rigid enough to do it this way. You must insert the OrthoSorb down the proximal phalanx and across the MPJ, leaving about 5 mm exposed at the proximal interphalangeal joint fusion site to place the middle phalanx over. You can also do this with the Trim-It pin if you do not want to cross the distal interphalangeal joint. Closure is normal from here and is the surgeon’s preference.

Final Notes

Postoperatively, the patient can weight bear immediately in a rigid post-op shoe or controlled ankle motion (CAM) walker. I prefer the CAM walker that also limits ankle motion. It is important to limit any potential motion at the MPJ joint while the surgical site begins to fibrose so the pin does not weaken and break. Depending on any other procedures you utilize, these patients are typically returning to an athletic style shoe at five weeks with use of a removable digital sling to keep the toe plantarflexed for the remaining healing process. One can control swelling with ½ inch Coflex or any other self-adherent wrap for compression as necessary.

   Overall, I have found this base resection with absorbable fixation and proximal interphalangeal joint fusion to be a very good and predictable procedure for the significantly subluxed or dislocated lesser MPJ. The procedure is not technically difficult yet is very effective at reducing significant subluxations and dislocations of the lesser MPJs.

   Dr. Tritto is board-certified in foot surgery by the American Board of Podiatric Surgery. He is in private practice in Rockville, Md.

References
1. Vanore JV. Use of absorbable pin stabilization of the lesser metatarsophalangeal joints. The Podiatry Institute Update 2007: Proceedings of the Annual Meeting of the Podiatry Institute, Ch. 3, The Podiatry Institute, Inc. Tucker, Ga., 2007, pp. 11-18.
2. Kelikian H. Deformities of the lesser toes. In: Kelikian H (ed): Hallux Valgus, Allied Deformities Of The Forefoot And Metatarsalgia. WB Saunders, Philadelphia, 1965, pp. 282-336.
3. Kelikian H, Clayton L, Loseff H. Surgical syndactylia of the toes. Clin Orthop 1961;19:208-231.

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