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:
- Excision of:
- metatarsal head.
- proximal phalanx.
- metatarsal exostosis.
- Distal metatarsal osteotomy.
- Soft-tissue correction of hallux valgus.
- 1st metatarsophalangeal joint arthrodesis.
- Dorsal wedge osteotomy for hallux rigidus.
- MTP joint replacement.
- Excision of:
- Place the patient Supine on the operating table
- Place a bump under ipsilateral hip.
- Landmarks:
- Head of the first metatarsal bone
- The metatarsophalangeal (MTP) joint.
- 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:
-
- Extensor hallucis longus:
- lies in lateral edge of wound.
- retract laterally.
- Flexor hallucis longus:
- lies in groove on the plantar surface of the proximal phalanx.
- may be injured during subperiosteal stripping.
- Extensor hallucis longus:
- Nerves:
- Dorsal digital branch of the medial cutaneous nerve.
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th