Treatment of Irreducible Second Metatarsophalangeal Joint Dislocation by Double Percutaneous Osteotomy: Haspell and Distal Metatarsal Mini-Invasive Osteotomy.

Abstract

Subluxation or dislocation of the second metatarsophalangeal joint may be commonly associated with crossover toe, metatarsalgia, and painful calluses. This retrospective study aims to evaluate the clinical and functional results in patients with irreducible second metatarsophalangeal joint dislocation treated by double percutaneous osteotomy in one step: Haspell's osteotomy and Distal Metatarsal Mini-Invasive Osteotomy. A total of 39 patients were included in this study. 31 patients had a simultaneous procedure on the first ray for hallux valgus correction. The American Orthopaedic Foot and Ankle Society score (AOFAS), the degree of joint range of motion (ROM) and hyperkeratosis of the second ray were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. The mean pre-operative AOFAS score was 62.76 ± 5.5, at 6 months after surgery it increased to a value of 78.81 ± 8.15 and at one year to a value of 88.78± 6.51. No differences in term of ROM were found between pre and postoperative values at 6 months. A significant improvement in ROM at 12 months was found. Hyperkeratosis, assessed with a nominal scale classification, decreased statistically significantly and, one year after surgery, in 88.88% of cases they completely resolved. The double percutaneous osteotomy brings advantages in terms of pain reduction. In conclusion, DMMO associated with Haspell's osteotomy is a safe and effective and reproducible technique in the resolution of metatarsalgia in patient with irreducible instability of the second metatarsophalangeal joint. LEVEL OF CLINICAL EVIDENCE: 4.