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Hi there,

Can someone please tell me when you would prescribe a Morton's extension for someone? What does it do?

Many thanks
Kara

 

What have you learned so far from googling Morton's extension?

Steven

 

Okay so I got you would use it for hallux rigidus.
A Morton's extension is a: A distal extension beyond the 1st MTPJ to limit movement at the 1st MTPJ and to transfer load to IPJ of hallux.
But if it's rigidus, there is already limit ROM, why would u use that other then pain relieve?
Is it palliative and you would be supporting the rigid ness?

 

The aim is to reduce dorsiflexion moments of the hallux. That IS reducing pain when you have a dorsal osteophyte. It works, but I can`t wear FM shoes any more. If only I knew of a friendly pod surgeon who could fix it with non-palliative care.

 

Hallux rigidus is not life threatening and you are correct, the Morton's extension is palliative and would be supporting the rigidness.

The terminology that I use is functional hallux limitus when there is a normal range of motion in OKC and Structural hallux limitus (SHL) when the ROM is 35 degrees or less in OKC. I use the term hallux rigidus when the joint has been fused from advanced arthritis. At this stage, there is no pain as there is no motion to inflame an osteochondral defect or dorsal osteophyte.

In later stages of SHL, there will be pain on end range of motion. This is commonly caused by increased hallux dorsiflexion stiffness so that during propulsion, the dorsal aspect of the base of the proximal phalanx is compressing against the head of the first metatarsal head. This commonly leads to osteochondritis desicans located at the dorsal central portion of the met head and is a common source of pain.

I will use a Morton's extension to terminate behind the IPJT to purposely decrease the available motion and decrease the compression as well as shearing across the osteochondral fragment. The extension can also help reduce the pain from a fractured dorsal osteophyte from preventing the base of the proximal phanlanx from constantly colliding into it during propulsion.

I have done my share of surgeries for structural hallux ridgidus as Morton's extension do not always work but you always want to exhaust conservature measures. Its not life threatening.

Steven

 

Kara,

Take a ruler and put it flat on a desk. It has no pivotting point.
Take a pencil and put it under the ruler 10 cm from the end(or 2/3 of the way along the ruler)

What happens?

 

Thanks heaps guys!!!
I get it now!

 

Hey Kara, careful the shoe that you put it in, it will need to have some form of rocker sole to replaced the mpj motion you have just blocked.

As Robin was pointing out with his "pencil n ruler" analogy or were you just explaining how to make a quick catapult Robin ?

 

Here is Morton's patent.

 

Simon, thanks for posting his patent. Interesting.

Steven