Treatment of Painful Subluxation or Dislocation at the Second and Third Metatarsophalangeal Joints by Partial Proximal Phalanx Excision and Subtotal Webbing

Abstract

Pain at the second or third metatarsophalangeal joint associated with objective instability and roentgenographic displacement is a common forefoot problem. In 53 patients (60 feet), surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of Toes 2 and 3 combined with subtotal webbing of the toes. At an average follow-up period of 29.8 months, 38% were wholly satisfied; 37%, satisfied with minor reservations; 15%, satisfied with major reservations; and 10% were not satisfied. When graded for pain, cosmesis, and footwear use, the most improvement was noted for pain symptoms. No significant effect of earlier forefoot surgery was noted. Residual complaints, such as persistent pain and unstable sensation of the webbed toes, were rarely disabling and usually minor compared to the preoperative status.