Silastic metatarsophalangeal joint replacement in the lesser toes: a successful salvage procedure

V. Sinclair, S. Garg

Introduction: The surgical options for the degenerative lesser metatarsophalangeal joint (MTPJ) or chronically dislocated MTPJs are limited and have traditionally included metatarsal shortening procedures where minimal degenerative change is present, or excision arthroplasty with more advanced changes. Although these procedures are successful in relieving pain, they may leave the patient with a short and/or floppy toe and transfer metatarsalgia. In our institution, we offer the patient a silastic MTPJ replacement. We present our case series.

Method: We retrospectively analysed data on consecutive patients undergoing lesser MTPJ silastic replacement using the Tornier Futura TM implant under the care of one Consultant Foot and Ankle surgeon over a five year period from May 2009 to June 2014. Demographic data, complications and patient satisfaction were recorded. Patient follow-up was performed at a single point in time by telephone and patients were asked if they were overall, satisfied with the procedure and secondly if they were experiencing any pain from the replaced joint.

Results: Data was collected on 25 toes of 23 feet in 20 patients. There were 3 males and 17 females. Median age was 59 (31-85). Diagnoses included 16 chronic MTPJ dislocations, 4 congruent arthritic MTPJs, 4 joints with avascular necrosis and secondary degenerative change and 1 dropped toe from a previous attempt at excision arthroplasty. 7 patients had undergone previous forefoot surgery. No patient experienced complications. 15 patients (75%) were available for follow-up. 14 (93%) patients were satisfied with the procedure. 10(67%) patients were completely pain free, 3 patients (20%) reported occasional pain and 2 (13%) reported problems with ongoing pain.

Conclusion: Treatment of the chronically dislocated lesser toe and advanced congruent degeneration at the MTPJ can be difficult to treat especially in an isolated digit. We believe that silastic replacements offer high patient satisfaction and satisfactory pain relief.