Problems of the second metatarsophalangeal joint

Diagnosis and treatment of second metatarsophalangeal joint problems are discussed. A new staging for Freiberg's disease is presented with differential treatment for each stage. Subluxation of the second metatarsophalangeal joint occurs commonly but is often unrecognized. A simple test in physical examination, the "positive Lachman" of the metatarsophalangeal joint is illustrated and explained. Although controversial, the etiology of synovitis of the second metatarsophalangeal joint is probably diverse; it can occur idiopathically or because of mechanical instabilities relating to malalignment of the first ray or disproportionate length of the second ray. When conservative treatment fails, surgical debridement of the joint is indicated. The second metatarsophalangeal is the most common chronically dislocated joint in the foot. The surgical goal is a reduced metatarsophalangeal joint and a stable toe. Surgical correction detailed by the authors involves a stepwise approach depending on the severity of the contracture, bony overlap, and deformity.