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[Static instability and dislocation of the 2nd metatarsophalangeal joint. Comparative analysis of 2 different
A Rochwerger1, F Launay, B Piclet
1Service d'Orthopédie Traumatologie, Hôpital de La Conception 147, Marseille.
Purpose Of The Study:
The authors report the results of instabilities and dislocations treatment of the second metatarsophalangeal joint using two different surgical methods.
Material And Methods:
This study included 129 patients (131 feet) with 19 instabilities, 43 subluxations and 69 dislocations of the second metatarsophalangeal joint. The first group of 66 patients (75 feet operated before 1994) had an arthrolysis using a dorsal approach associated to a lengthening of the tendon extensor digitorum longus. Reduction of the metatarsophalangeal joint was fixed by a K wire (15 feet of this group had an associated basimetatarsal osteotomy). The second group of 53 patients (56 feet operated since 1994) had the association of arthrolysis, tendon lengthening, and distal metatarsal osteotomy according to S. Weil.
Results:
Results were appreciated on different criterions: deformity recurrence, emergence of metatarsalgia on the adjacent ray, discomfort in walking and shoe wearing. Results are significantly better in the second group of patients.
Discussion:
The main cause of second ray lesions is related to metatarsal relative length abnormality. The authors compare different surgical techniques for the metatarsophalangeal joint, distally and proximally to it, and assess indications.
Conclusion:
The better the relative length abnormality is corrected, the better is the prognosis after treatment.