title: Hemiphalangectomy and syndactylization for treatment of osteoarthritis and dislocation of the second metatarsal phalangeal joint: an outcome study.
abstract: End-stage osteoarthritis or severe dislocation at the second metatarsophalangeal joint typically presents with chronic pain and is often unrelieved by conservative treatment. The aim of this article is to review the preliminary outcomes of surgery involving resection of the base of the second proximal phalanx with syndactylization to the third toe for stability. Thirteen patients (13 feet) with second metatarsophalangeal osteoarthritis and 15 patients (15 feet) with a dislocated second toe underwent the procedure and were reviewed after a mean 12.4 months (range, 5-25 months). Patients were evaluated preoperatively and postoperatively with the American Orthopedic Foot and Ankle Society's scoring system and clinical review. A patient questionnaire was devised to yield information regarding toe alignment, cosmesis, and reflection on the procedure. Pain and activities were significantly improved in both subgroups (P < .01). Eighty-two percent were very satisfied or satisfied with the reduction in symptoms, with 11% satisfied with reservations and 7% not satisfied. Seventy-nine percent were very satisfied or satisfied with the appearance. Thirty-nine percent stated the outcome was better than expected, 14% as expected, and 14% felt the result was worse than expected. Twenty-three patients (82%) had no postoperative cosmetic concerns, and 7 patients (25%) felt there was a moderate or severe difference in the alignment with respect to the other toes. In conclusion, syndactylization can significantly improve pain and activity levels and was found to be cosmetically acceptable.
authors.affiliation: Dept. of Podiatric Surgery, West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex, UK. sfeeney@aol.com
authors.forename: Sally
authors.initials: S
authors.lastname: Feeney
authors.forename: Sharon
authors.initials: S
authors.lastname: Rees
authors.forename: Mark
authors.initials: M
authors.lastname: Tagoe
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004954:Esthetics; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011032:Podiatry / Q000379:methods*; D011795:Surveys and Questionnaires; D050277:Toe Phalanges / Q000601:surgery*; D016896:Treatment Outcome