Members do not see these Ads. Sign Up.

Hello
I had R/1st mtpjt fusion 3 years. In the last 6 months or so, however, I have developed severe pain in the R/1st ipjt, which now has limited range of motion and dorsal osteophytes. I also have a painful 'lump' under the prox phalanx which results in very heavy callus formation.
I have had steroid injections and offloading insoles. I was just wondering how any of the surgeons would manage this.
Thanks in advance.
TB

 

You would need an x-ray to evaluate but it is possible the plantar prominence is fixation irritation. The IPJ issue is a little bit more of a problem because, if it is painful enough, you may require surgery to this joint if conservative care is not helping.

Only two primary options - arthroplasty but this might pre-dispose to irritation / pain at the remaining stump of the proximal phalanx. Arthrodesis of this joint will resolve the IPJ pain but increase plantar load. The only other option is to consider the sagittal plane position of the hallux. If it has been fused relatively flat, then this could load the IPJ more. A dorsiflexion osteotomy of the proximal phalanx may help in this instance.

 

Thanks very much Trevor. I was wondering, would a cheilectomy be a possible option also?

 

We do not commonly do it for an IPJ although it could be considered - the mail thing is to work out why that joint is being loaded.