Destruction of MTPJs

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Hi All,
I would love any opinions from people who have seen the results of the surgery I am about to describe, or anyone for that matter who has a considered opinion.

I have a client who is 66 years old and active who has advanced osteoarthritis in her hips, knees, and feet. In her left foot she has stage 3 HAV, a second digit with hypertrophied DIPJ and surrounding soft tissue, and semi-rigid retracted digits 3, 4, 5.

The second digit is her worst problem as she has presented with an ulcer on the medial aspect of the DIPJ after not coming in soon enough. Conservative treatment has quickly resolved said ulcer.

She went to see an orthopaedic surgeon a couple of weeks ago who proposed the following surgery: Arthrodesis of the hallux, filleting of the second, and destruction of MTPJs 2,3,4,5 and allowing the digits to "float."

I have some concerns about this type of surgery adversely affecting her foot function and therefore her way of life. She has significant trouble with her left hip due to the current function of the left foot.

Any ideas??
Regards,
Matt.

 

Matt

I suspect this is essentially a pan metatarsal head resection, but substituting an arthrodesis for the 1st MTPJ instead of arthroplasty (which is common practice).

It is used widely for severe defomrity in the rheumatoid foot, and can provide marked improvement in mobility and comfort. There is also a place for it in a severely deformed non-rheumatoid foot, particularly in the elderly with low weight bearing demands.

For marked forefoot derangement this is often the procedure of choice, though there will be slight variations on this depending on the surgeon. It really depends on the symptoms, and failure of any conservative care to address the problem.

LL

 

"I have some concerns about this type of surgery adversely affecting her foot function..."

I would think it would!

I agree with LL.. except perhaps re: the first MTPJ.

In my experience, if the panmetahead is indicated, the first MTPJ should also have a resectional arthroplasty, not a fusion. They heal faster, have less complications and are less painful.

My 2 Cents

Steve