Lesser Toe MTP Joint Approach

  • 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.

  • 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:
    • 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.

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

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

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

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

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

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Lesser Toe MTP Joint Approach Lesser Toe MTP Joint Approach Lesser Toe MTP Joint Approach Lesser Toe MTP Joint Approach
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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