Hammertoes pp 403-413 | Cite as

Lesser Metatarsal Head with Avascular Necrosis and Revision PIPJ Distraction Arthrodesis

  • Jacob WynesEmail author


Second metatarsophalangeal joint (MTPJ) instability in the setting of a shortened first ray may lead to metatarsalgia, digital edema, and recalcitrant pain, which often fails conservative therapy. Appropriate recognition of the pathology and addressing the metatarsal parabola and tri-planar nature of this deformity are important in achieving good clinical outcomes. Even with meticulous surgical technique, the inherent biology of the bone may become attenuated resulting in flattening of the articular surface, thereby, precipitating recurrence of deformity. Fortunately, options exist for the surgical correction of second ray shortening and managing avascular necrosis through the use of arthrodiastasis, core decompression supplemented with stem cell augmentation, and autogenous grafting for interpositional proximal interphalangeal joint arthrodesis.


Avascular necrosis Freiberg Hammertoe Arthrodiastasis Distraction 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity of Maryland School of MedicineBaltimoreUSA

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