Problems of the second metatarsophalangeal joint

Area of Science:

• Orthopedics
• Podiatry
• Sports Medicine

Background:

• Second metatarsophalangeal (MTP) joint problems are common but often overlooked.
• Subluxation of the second MTP joint is a frequent, yet underdiagnosed, condition.
• Etiologies for synovitis include idiopathic factors and biomechanical instabilities like first ray malalignment.

Purpose of the Study:

• To discuss the diagnosis and treatment of second MTP joint disorders.
• To introduce a novel staging system for Freiberg's disease with stage-specific treatments.
• To highlight the "positive Lachman" test for MTP joint subluxation.

Main Methods:

• Review of diagnostic criteria for second MTP joint pathologies.
• Presentation of a new staging system for Freiberg's disease.
• Description of the "positive Lachman" physical examination test.
• Explanation of surgical techniques for MTP joint correction.

Main Results:

• A new staging for Freiberg's disease is proposed.
• The "positive Lachman" test is identified as a key diagnostic indicator.
• Surgical intervention is indicated for persistent synovitis and chronic dislocation.
• A stepwise surgical approach is detailed based on deformity severity.

Conclusions:

• Accurate diagnosis and tailored treatment are crucial for second MTP joint problems.
• The new Freiberg's disease staging offers a framework for differential management.
• Surgical goals focus on MTP joint reduction and toe stability.
• Addressing biomechanical factors is important in managing MTP joint synovitis.