Skip to main content
SpringerLink
Log in

Revision Surgery for the Lesser Metatarsophalangeal Joints

  • Chapter
  • First Online:
Revision Surgery of the Foot and Ankle

  • 619 Accesses

Abstract

Procedures addressing the lesser metatarsophalangeal joints (MTPJ) are used as part of the operative management of metatarsalgia, lesser toe deformity, MTPJ instability, or bunionette deformity. Even though these procedures typically lead to favorable results, there is a subset of patients that will present with recurrent pain and deformity. Requirement for revision surgery in this segment is usually the result of sub-optimal initial surgical planning, incorrect choice of primary procedure, or underestimation of the underlying progressive pathologic process. The management of patients with recurrent pain and deformity after surgery involving the lesser MTPJ is challenging. Outcome expectations should be addressed with understanding of risks and the possibility of incomplete recovery with residual pain, swelling, deformity, or disability. We present our recommendations and revision strategies for the most common complications involving the lesser MTPJ as recurrent/transfer metatarsalgia, floating toe, chronic instability, coronal malalignment, osteoarthritis, and recurrent bunionette deformity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin. 2011;16(4):583–95.

    Article  PubMed  Google Scholar 

  2. Hofstaetter SG, Hofstaetter JG, Petroutsas JA, Gruber F, Ritschl P, Trnka HJ. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg (Br). 2005;87-B(11):1507–11.

    Article  Google Scholar 

  3. Doty JF, Coughlin MJ, Weil L Jr, Nery C. Etiology and management of lesser toe metatarsophalangeal joint instability. Foot Ankle Clin. 2014;19(3):385–405.

    Article  PubMed  Google Scholar 

  4. Chadwick C, Saxby TS. Hammertoes/Clawtoes: metatarsophalangeal joint correction. Foot Ankle Clin. 2011;16(4):559–71.

    Article  PubMed  Google Scholar 

  5. Weil L Jr, Weil LS Sr. Osteotomies for bunionette deformity. Foot Ankle Clin. 2011;16(4):689–712.

    Article  PubMed  Google Scholar 

  6. Maceira E, Monteagudo M. Transfer metatarsalgia post hallux valgus surgery. Foot Ankle Clin. 2014;19(2):285–307.

    Article  PubMed  Google Scholar 

  7. Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchman J. Complications of the Weil Osteotomy. Foot Ankle Spec. 2011;4(3):165–70.

    Article  PubMed  Google Scholar 

  8. Trnka HJ, Gebhard C, Muhlbauer M, Ivanic G, Ritschl P. The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies. Acta Orthop Scand. 2002;73(2):190–4.

    Article  PubMed  Google Scholar 

  9. Devos Bevernage B, Leemrijse T. Predictive value of radiographic measurements compared to clinical examination in the preoperative planning for a Weil osteotomy. Foot Ankle Int. 2008;29:142–9.

    Article  CAS  PubMed  Google Scholar 

  10. Barouk P. Recurrent metatarsalgia. Foot Ankle Clin. 2014;19(3):407–24.

    Article  PubMed  Google Scholar 

  11. Khurana A, Kadamabande S, James S, Tanaka H, Hariharan K. Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia. Foot Ankle Surg. 2011;17(3):150–7.

    Article  CAS  PubMed  Google Scholar 

  12. Perez-Munoz I, Escobar-Anton D, Sanz-Gomez TA. The role of Weil and triple Weil osteotomies in the treatment of propulsive metatarsalgia. Foot Ankle Int. 2012;33(6):501–6.

    Article  PubMed  Google Scholar 

  13. Trnka HJ, Nyska M, Parks BG, Schon LC. Dorsiflexion contracture after the Weil osteotomy: results of cadaver study and three-dimensional analysis. Foot Ankle Int. 2001;22(1):47–50.

    Article  CAS  PubMed  Google Scholar 

  14. Snyder J, Owen J, Wayne J, Adelaar R. Plantar pressure and load in cadaver feet after a Weil or Chevron osteotomy. Foot Ankle Int. 2005;26(2):158–65.

    Article  PubMed  Google Scholar 

  15. Maestro M, Besse J-L, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003;8(4):695–710.

    Article  PubMed  Google Scholar 

  16. Melamed EA, Schon LC, Myerson MS, Parks BG. Two modifications of the Weil osteotomy: analysis on Sawbone models. Foot Ankle Int. 2002;23(5):400–5.

    Article  PubMed  Google Scholar 

  17. Lau JTC, Stamatis ED, Parks BG, Schon LC. Modifications of the Weil osteotomy have no effect on plantar pressure. Clin Orthop Relat Res. 2004;421:194–8.

    Article  Google Scholar 

  18. Pearce CJ, Calder JD. Metatarsalgia: Proximal Metatarsal Osteotomies. Foot Ankle Clin. 2011;16(4):597–608.

    Article  PubMed  Google Scholar 

  19. Derner R, Meyr AJ. Complications and salvage of elective central metatarsal osteotomies. Clin Podiatr Med Surg. 2009;26(1):23–35.

    Article  PubMed  Google Scholar 

  20. Trnka HJ, Muhlbauer M, Zettl R, Myerson MS, Ritschl P. Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints. Foot Ankle Int. 1999;20(2):72–9.

    Article  CAS  PubMed  Google Scholar 

  21. Migues A, Slullitel G, Bilbao F, Carrasco M, Solari G. Floating-toe deformity as a complication of the Weil osteotomy. Foot Ankle Int. 2004;25(9):609–13.

    Article  PubMed  Google Scholar 

  22. Garg R, Thordarson DB, Schrumpf M, Castaneda D. Sliding oblique versus segmental resection osteotomies for lesser metatarsophalangeal joint pathology. Foot Ankle Int. 2008;29(10):1009–14.

    Article  PubMed  Google Scholar 

  23. Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes. J Foot Ankle Surg. 2014;53(4):440–5.

    Article  PubMed  Google Scholar 

  24. Sferra J, Arndt S. The crossover toe and valgus toe deformity. Foot Ankle Clin. 2011;16(4):609–20.

    Article  PubMed  Google Scholar 

  25. Barg A, Courville XF, Nickisch F, Bachus KN, Saltzman CL. Role of collateral ligaments in metatarsophalangeal stability: a cadaver study. Foot Ankle Int. 2012;33(10):877–82.

    Article  PubMed  Google Scholar 

  26. Nery C, Coughlin MJ, Baumfeld D, Raduan FC, Mann TS, Catena F. Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears. Foot Ankle Int. 2014;35(9):876–85.

    Article  PubMed  Google Scholar 

  27. Flint WW, Macias DM, Jastifer JR, Doty JF, Hirose CB, Coughlin MJ. Plantar plate repair for lesser metatarsophalangeal joint instability. Foot Ankle Int. 2016;38(3):234–42.

    Article  PubMed  Google Scholar 

  28. Haddad SL, Sabbagh RC, Resch S, Myerson B, Myerson MS. Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity. Foot Ankle Int. 1999;20(12):781–8.

    Article  CAS  PubMed  Google Scholar 

  29. Nickisch F, Hodges Davis W. Basilar proximal phalangeal osteotomy (Akinette) for recalcitrant lesser-toe horizontal plane deformities. Tech Foot Ankle Sur. 2008;7(1):41–4.

    Article  Google Scholar 

  30. Hodges Davis W, Anderson RB, Thompson FM, Hamilton WG. Proximal phalanx basilar osteotomy for resistant angulation of the lesser toes. Foot Ankle Int. 1997;18:103–4.

    Article  Google Scholar 

  31. Boyer ML, DeOrio JK. Transfer of the flexor digitorum longus for the correction of lesser-toe deformities. Foot Ankle Int. 2016;28(4):422–30.

    Article  Google Scholar 

  32. Kwon JY, De Asla RJ. The use of flexor to extensor transfers for the correction of the flexible hammer toe deformity. Foot Ankle Clin. 2011;16(4):573–82.

    Article  PubMed  Google Scholar 

  33. Myerson MS, Jung HG. The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. Foot Ankle Int. 2005;26(9):675–9.

    Article  PubMed  Google Scholar 

  34. Bhatia D, Myerson MS, Curtis MJ, Cunningham BW, Jinnah RH. Anatomical restraints to dislocation of the second metatarsophalangeal joint and assessment of a repair technique. J Bone Joint Surg Am. 1994;76:1371–5.

    Article  CAS  PubMed  Google Scholar 

  35. Myers SH, Schon LC. Forefoot tendon transfers. Foot Ankle Clin. 2011;16(3):471–88.

    Article  PubMed  Google Scholar 

  36. Capobianco CM. Surgical treatment approaches to second metatarsophalangeal joint pathology. Clin Podiatr Med Surg. 2012;29(3):443–9.

    Article  PubMed  Google Scholar 

  37. Kilic A, Cepni KS, Aybar A, Polat H, May C, Parmaksizoglu AS. A comparative study between two different surgical techniques in the treatment of late-stage Freiberg’s disease. Foot Ankle Surg. 2013;19(4):234–8.

    Article  PubMed  Google Scholar 

  38. Cerrato RA. Freiberg’s disease. Foot Ankle Clin. 2011;16(4):647–58.

    Article  PubMed  Google Scholar 

  39. Helix-Giordanino M, Randier E, Frey S, Piclet B. French association of foot s. treatment of Freiberg’s disease by Gauthier’s dorsal cuneiform osteotomy: retrospective study of 30 cases. Orthop Traumatol Surg Res. 2015;101(6 Suppl):S221–5.

    Article  CAS  PubMed  Google Scholar 

  40. Erdil M, Imren Y, Bilsel K, Erzincanli A, Bulbul M, Tuncay I. Joint debridement and metatarsal remodeling in Freiberg’s infraction. J Am Podiatr Med Assoc. 2013;103(3):185–90.

    Article  PubMed  Google Scholar 

  41. Xie X, Shi Z, Gu W. Late-stage Freiberg’s disease treated with dorsal wedge osteotomy and joint distraction arthroplasty: technique tip. Foot Ankle Int. 2012;33(11):1015–7.

    Article  PubMed  Google Scholar 

  42. Nixon DC, McKean RM, Klein SE, Johnson JE, McCormick JJ. Rheumatoid forefoot reconstruction in the nonrheumatoid patient. Foot Ankle Int. 2017;38(6):605–11.

    Article  PubMed  Google Scholar 

  43. Schade VL. Surgical management of Freiberg’s infraction: a systematic review. Foot Ankle Spec. 2015;8(6):498–519.

    Article  PubMed  Google Scholar 

  44. Gauthier G, Elbaz R. Freiberg’s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res. 1979;(142):93–5.

    Google Scholar 

  45. Kim J, Choi WJ, Park YJ, Lee JW. Modified Weil osteotomy for the treatment of Freiberg’s disease. Clin Orthop Surg. 2012;4(4):300.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mann RA, Chou LB. Surgical management for intractable metatarsalgia. Foot Ankle Int. 1995;16(6):322–7.

    Article  CAS  PubMed  Google Scholar 

  47. Giannini S, Faldini C, Vannini F, Digennaro V, Bevoni R, Luciani D. The minimally invasive osteotomy “S.E.R.I.” (simple, effective, rapid, inexpensive) for correction of bunionette deformity. Foot Ankle Int. 2008;29(3):282–6.

    Article  PubMed  Google Scholar 

  48. Bertrand T, Parekh SG. Bunionette deformity: etiology, nonsurgical management, and lateral exostectomy. Foot Ankle Clin. 2011;16(4):679–88.

    Article  PubMed  Google Scholar 

  49. Lee DC, de Cesar Netto C, Staggers JR, Siegel R, Chen R, Bae S-Y, et al. Clinical and radiographic outcomes of the Kramer osteotomy in the treatment of bunionette deformity. Foot Ankle Surg. 2017

    Google Scholar 

  50. Baumhauer JF, Digiovanni BF. Osteotomies of the fifth metatarsal. Foot Ankle Clin. 2001;6(3):491–8.

    Article  CAS  PubMed  Google Scholar 

  51. Cooper MT, Coughlin MJ. Subcapital oblique osteotomy for correction of bunionette deformity. Foot Ankle Int. 2013;34(10):1376–80.

    Article  PubMed  Google Scholar 

  52. Weitzel S, Trnka HJ, Petroutsas J. Transverse medial slide osteotomy for bunionette deformity: long-term results. Foot Ankle Int. 2007;28(7):794–8.

    Article  PubMed  Google Scholar 

  53. Michels F, Van Der Bauwhede J, Guillo S, Oosterlinck D, de Lavigne C. Percutaneous bunionette correction. Foot Ankle Surg. 2013;19(1):9–14.

    Article  PubMed  Google Scholar 

  54. Magnan B, Samaila E, Merlini M, Bondi M, Mezzari S, Bartolozzi P. Percutaneous distal osteotomy of the fifth metatarsal for correction of bunionette. J Bone Joint Surg Am. 2011;93(22):2116–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes, Las Condes, Chile

    Gonzalo F. Bastías

  2. Department of Orthopedic Surgery, Universidad de Chile Complejo Hospitalario San José, Santiago, Chile

    Gonzalo F. Bastías

  3. Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Department of Orthopaedic Surgery, Bangkok, Thailand

    Jakrapong Orapin

  4. Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA

    Lew C. Schon

  5. Georgetown School of Medicine, Washington, DC, USA

    Lew C. Schon

  6. Johns Hopkins University, Baltimore, MD, USA

    Lew C. Schon

  7. Fischell Literati Faculty, University of Maryland, Fischell Department of Bioengineering, College Park, MD, USA

    Lew C. Schon

Authors
  1. Gonzalo F. Bastías
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jakrapong Orapin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lew C. Schon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gonzalo F. Bastías .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Mark J. Berkowitz

  2. Florida Orthopaedic Institute, Temple Terrace, FL, USA

    Michael P. Clare

  3. Department of Orthopedic Surgery, Oakland University William Beaumont, Royal Oak, MI, USA

    Paul T. Fortin

  4. Medstar Union Memorial Hospital, Baltimore, MD, USA

    Lew C. Schon

  5. Florida Orthopedic Institute, Temple Terrace, FL, USA

    Roy W. Sanders

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bastías, G.F., Orapin, J., Schon, L.C. (2020). Revision Surgery for the Lesser Metatarsophalangeal Joints. In: Berkowitz, M., Clare, M., Fortin, P., Schon, L., Sanders, R. (eds) Revision Surgery of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-030-29969-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-29969-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-29968-2

  • Online ISBN: 978-3-030-29969-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation