Surgical correction of central metatarsalgia and middle hammer toes deformity using resection arthroplasty of the metaproophalangeal joints

Abstract

Aim of the study. To evaluate the effectiveness of resection arthroplasty of the metatarsophalangeal joints (MTP joints) in the surgical treatment of hammer toe deformity of the II­III­IV toes, accompanied by severe overload metatarsalgia.The results of surgical treatment of hammertoe deformity of 102 toes on 50 feet in 36 patients (32 women and 4 men) aged 39 to 79 years (median age 58 [54; 64] years) were studied. Long­term results were followed­up from 8 to 50 months (median – 30 [25; 38] months). Treatment outcomes were assessed by determining the placement of hammer toes in the joints, measuring the passive range of motion (PROM) in the MTP joint, calculating the forefoot X­ray parameters, using the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society Lesser Toe Scale (AOFAS­II­V). The measurement the PROM in the 2nd, 3rd and 4th MTP joints showed a decrease in their amplitude by 20.3–22.8 % in the long­term period after surgery. The pain assessment according to the VAS scale showed a decrease in the median value from6 [6; 7] points before surgery up to 2 [1; 4] – after the surgical procedure, and the median score on the AOFAS­II­V scale increased from 35 [30; 45] to 79 [65; 85] points. Positive outcomes were achieved in 88 % of cases. The results of the study indicate the effectiveness of resection arthroplasty of the MTP joints in the treatment of overload metatarsalgia with hammer toe deformity of the 2nd, 3rd and 4th toes. Shortening of the middle metatarsals easily correct hammer toe deformity and eliminate pain. At the same time, the disadvantage of the technique is a decrease range of motion (ROM) in the resected MTP joints, therefore, early and active development of movements in the postoperative period is necessary.