Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Interpositional Arthroplasty of the Great Toe


Indications

  • Arthritis of the first metatarsophalangeal (MTP) joint beyond cheilectomy treatment

  • Concomitant arthritis of the sesamoid bones

  • Failed cheilectomy

Indications Pitfalls

  • Very stiff joints may be better fused; do not expect as much motion.

  • Infected joints may need a two-stage procedure.

  • Hallux varus or other severe instabilities may require simultaneous ligamentous reconstruction (see Stein, Miller article).

Indications Controversies

  • Very stiff joint may do better with fusion

  • Very unstable joints may do better with fusion

  • Perhaps a good option for nonunion of prior first MTP fusion

  • Prior hemiarthroplasty may do well with simple implant removal

Examination and Imaging

  • Anteroposterior foot longstanding hallux rigidus in a 62-year-old woman ( Fig. 10.1 )

    FIG. 10.1

  • Lateral foot films of the same 62-year-old woman ( Fig. 10.2 )

    FIG. 10.2

Treatment Options

  • Footwear modifications

  • Antiinflammatory medications

  • Cheilectomy with or without microfracture

  • Arthrodesis

Surgical Anatomy

  • Dorsomedial cutaneous nerve ( Fig. 10.3 )

    FIG. 10.3

  • Extensor hallucis longus (EHL) tendon

  • MTP joint capsule

Positioning

Positioning Pearls

  • Occasionally a small bump under the ipsilateral hip helps to position the foot.

Positioning Equipment

  • A small bump or beanbag may be helpful.

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