Silicone implant arthroplasty for second metatarsophalangeal joint disorders with and without hallux valgus deformities

Abstract

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.