This patient presented with a painful enlarged 2nd MTPJ, but her main concern was the fact that the associated 2nd toe is “floppy” and catches on the ground. She has had previous surgery on this 2nd MTPJ when in her 20s. She can no longer walk barefoot, and it is now leading to her tripping.
She has been sent for X-rays as I suspect she has an old Freiberg’s infraction of this joint that has progressed from a previous attempted “tidy up”. The joint is enlarged clinically and there is a bony block on attempted dorsiflexion.
As for her main concern, she cannot dorsiflex the toe at all, and, when she attempts to dorsiflex all the toes, the 2nd remains plantar flexed. Ultrasound assessment has shown that the extensor digitorum longus is “torn”. The EDL tendon may have been severed during previous surgery or the enlarged dorsal spurring may have served the tendon. Whatever the cause it requires repairing.
The surgery would involve debriding the Freiberg’s and carrying out a capsular interpostional arthroplasty to attain long-term pain-free motion at the joint and a repair of the tendon. I will carry out an ultrasound assessment just before the surgery to try to identify both ends of the tendon and if there is a large gap and a tendon graft may be required.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Freiberg’s Disease/Infraction
Dislocated 2nd MTPJ
(This content is intended for healthcare professionals only)