Wong-Chung John, Arneill Matthew, Lloyd Richard
Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK; University of Ulster, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
Foot Ankle Surg. 2018 Jun;24(3):e18-e22. doi: 10.1016/j.fas.2018.04.001. Epub 2018 Apr 11.
We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1).
Of 438 MTP1 arthrodeses performed over a 13-year period, 12 feet returned with a painful keratoma beneath a gradually hyperextending interphalangeal joint of the great toe (IPJ1) from unexcised, unrecognized or recognized HIPJS. We identified another 7 feet with HIPJS, which did not develop symptoms after MTP1 arthrodesis. Angles at which arthrodesis had been performed were measured.
All big toes had been arthrodesed in good position, clinically and radiologically, with no difference between the two groups in angles subtended by the proximal phalanx of the arthrodesed big toe with the ground. Good outcomes followed surgical excision of the symptomatic HIPJS.
The presence of a HIPJS should be excluded in the differential diagnosis of IPJ1 symptoms developing after MTP1 arthrodesis. Furthermore, one should look out for and consider prophylactic excision of a HIPJS at time of MTP1 arthrodesis.
