Instability of the Lesser Metatarsophalangeal Joints


Instability of the lesser metatarsophalangeal (MTP) joints is a common problem that may occur with synovitis, systemic arthritis, and trauma. MTP joint instability is generally manifested clinically as an ill-defined forefoot pain that can be mistaken as neuritic in origin. Conservative treatment is recommended initially and consists of wearing shoes with roomy toe box areas to accommodate the toes and metatarsal pads to help reduce the pressure under the MTP joint and reduce the synovitis. Surgical treatment is determined by the magnitude of the deformity and its rigidity. For flexible, reducible deformities, the author recommends a metatarsal-shortening Weil osteotomy, following tenotomy and dorsal capsulotomy, to shorten the collateral ligaments and reduce the MTP joint. For fixed, dislocated deformities, an extensive release of the dorsal, medial, or lateral structures should be performed, followed by a Weil osteotomy. Reefing of the elongated structures should complete the correction, and a tendon transfer should be added to aid in the stability of the joint.

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