This was a very symptomatic 2nd MTPJ that had progressed for many years. Conservative care has been exhausted, and the patient was referred for a surgical consultation. Please see the left image for decreased joint space, subchondral sclerosis and bony spurring. Range of motion was limited with dorsal jamming and marked crepitus.
My procedure of choice for this condition is a variation of the capsular interpositional arthroplasty that I carry out for hallux rigidus. I make a small dorsal incision and gain access to the joint via a dorsal incision into the capsule, ensuring I preserve that capsule. The joint is then remodelled and debulked to allow a free and unencumbered range of motion. The thickened and fibrosed capsule is then sutured or interposed into the joint space to maintain pain-free movement.
Note the increased joint space in the postoperative image on the right. This is the same procedure I use for Freiberg’s Infraction. Great long-term results are typically seen.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Hallux Limitus / Rigidus
Post-operative wounds
Dislocated 2nd MTPJ
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