Lesser Toe MTP Joint Approach indications:

  • Lesser Toe MTP Joint Approach which exposes the metatarsophalangeal joints of the second, third, fourth, and fifth toes, avoids incision of the plantar skin of the foot. 
  • Lesser Toe MTP Joint Approach uses include the following:
    1. Excision of metatarsal heads.
    2. Distal metatarsal osteotomy.
    3. Partial proximal phalangectomy.
    4. Fusion of metatarsophalangeal joints (rare).
    5. Capsulotomy of metatarsophalangeal joints.
    6. Muscle tenotomy.
    7. Neurectomy.

Position of the Patient

  • place the patient Supine on operating table with a bolster under the thigh to flex the knee and keep the foot plantigrade on the table.

Landmarks and Incision

  • Landmarks:
    • The Metatarsal head of the finger.
    • The tendons of the extensor digitorum longus.
  • Incision:
    • Make 2-3cm dorsolateral incision parallel to corresponding extensor tendons.
    • If 2 adjacent joints need to be exposed, make the incision between them.

Internervous plane

  • There is no internervous plane for Lesser Toe MTP Joint Approach.

Superficial dissection

  • Incise the deep facia in line with the incision.
  • Retract the extensor tendon to reveal the MTP joint.

Deep dissection

  • Perform transverse or longitudinal arthrotomy.
  • Retract the joint capsule to expose the MTP joint.

Approach Extension

  •  The approach rarely is enlarged and is used primarily for specific web space pathology.

Dangers

  • The structures at risk during Lesser Toe MTP Joint Approach include:
    1.  Digital nerve and vessel.

References

  • Surgical Exposures in Orthopaedics book – 4th Edition
  • Campbel’s Operative Orthopaedics book 12th