This is an interesting case I have dealt with recently. The patient was sent to me with long-standing, markedly painful and stiff 1st metatarsophalangeal joints (MTPJ).
Clinical examination showed no dorsiflexion with the patient guarding the joint due when any motion was attempted. All conservative care had been exhausted with no success.
Weight-bearing radiographs exposed a very long 1st metatarsal as can be seen on the left image – this was leading to a jamming of the joint. As this had been present for many years and was debilitating, the patient was eager to move to surgery. A distal osteotomy was carried out to shorten and slightly plantarflex the metatarsal; this is a modification of the Austin/chevron bunion osteotomy, yet with no lateral shift of the head. Note the correct length on the radiograph (right). This instantly returned a normal range of motion, stopped the pain and will now preserve the joint and avoid cartilage wear.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Subungual exostoses
Gout or degenerative osteoarthrosis/hallux limitus?
Posterior heel pain
Ultrasound in the operating theatre
Gout deposits (not bunions)
Freiberg’s Disease/Infraction
Gout
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