Dorsomedial Approach to MTP Joint

  • Dorsomedial Approach to MTP Joint of Great Toe makes possible most surgery on the metatarsophalangeal joint of the great toe for the treatment of bunions or hallux rigidus. 

  • Dorsomedial Approach to MTP Joint of Great Toe uses include the following:
    1. Excision of:
      • metatarsal head.
      • proximal phalanx.
      • metatarsal exostosis.
    2. Distal metatarsal osteotomy.
    3. Soft-tissue correction of hallux valgus.
    4. 1st metatarsophalangeal joint arthrodesis.
    5. Dorsal wedge osteotomy for hallux rigidus.
    6. MTP joint replacement.

  • Place the patient Supine on the operating table
  • Place a bump under ipsilateral hip.

  • Landmarks:
    1. Head of the first metatarsal bone
    2. The metatarsophalangeal (MTP) joint.
    3. The extensor hallucis longus tendon.
  • Incision:
    • Make a 5-6 cm incision medial and parallel to tendon of extensor hallucis longus (EHL).
    • Start 2-3 cm proximal to MTP joint.
    • Extend distally to the proximal interphalangeal joint.

  • There is no true internervous plane for Dorsomedial Approach to MTP Joint of Great Toe.
  • The bone is subcutaneous; the two tendons close to the dissection, the extensor hallucis longus and the abductor hallucis, receive their nerve supplies proximal to this approach and cannot be denervated by it.

  • Incise deep fascia in line with incision.
  • Retract extensor hallucis longus EHL laterally.
  • Retract dorsal digital branch of the medial cutaneous nerve laterally.

  • Make a U-shaped incision through joint capsule
    • Base of the flap should attach at base of proximal phalanx

  • The Dorsomedial Approach to MTP Joint of Great Toe cannot be extended usefully to other joints in the foot,
  • It may be extended proximally for access to the shaft of the metatarsus.

  • The structures at risk during the Dorsomedial Approach to MTP Joint of Great Toe  includes:
    • Tendons:
      1. Extensor hallucis longus:
        • lies in lateral edge of wound.
        • retract laterally.
      2. Flexor hallucis longus:
        • lies in groove on the plantar surface of the proximal phalanx.
        • may be injured during subperiosteal stripping.
    • Nerves:
      • Dorsal digital branch of the medial cutaneous nerve.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Dorsomedial Approach to MTP Joint of Great Toe Dorsomedial Approach to MTP Joint of Great Toe Dorsomedial Approach to MTP Joint of Great Toe Dorsomedial Approach to MTP Joint of Great Toe Dorsomedial Approach to MTP Joint of Great Toe

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Related Approches

  • Medial Approach to Calcaneus
  • Lateral Approach to Calcaneus
  • U Approach to Calcaneus
  • Lesser Toe MTP Joint Approach
  • Ollier Approach to the Tarsus

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