Metatarsophalangeal Joint Procedures

Abstract

The first step is restoring mobility by resecting osteophytes. The second step is release of the shortened plantar structures – both the joint capsule and the short flexor tendons – caused by chronic decreased extension. In contrast to the conventional technique, this technique includes the phalangeal capsule at the tendon insertion (flexor hallucis brevis muscle) rather than the metatarsal region alone. Dissection must be very careful here to avoid detaching the short foot flexors. To augment the release surgery and improve the joint mechanics, areas with absent cartilage (Outerbridge type IV) are treated with traditional microfracture to induce regenerated cartilage. This uses a special awl that is somewhat smaller than that used for microfracture at the ankle and knee. The «chess board» pattern is somewhat tighter, with a distance of about 2 mm between perforations.