Gazdag A, Cracchiolo A
Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, California 90095-6902, USA.
Foot Ankle Int. 1998 Mar;19(3):137-43. doi: 10.1177/107110079801900304.
An unstable second metatarsophalangeal joint may produce pain in the forefoot. Eighteen patients (20 feet) had a transfer of the flexor digitorum longus to the extensor side of the base of the proximal phalanx performed as the primary procedure to stabilize this painful joint. Most patients had a hallux valgus deformity that also required correction, because it either was also symptomatic or was preventing adequate reduction of the second toe. A ruptured plantar plate of the second metatarsophalangeal joint was demonstrated in 13 feet and in these joints appeared to be the cause of the vertical instability. However, all feet showed an unstable joint upon clinical examination. A vertical-stress test almost always reproduced the patient's pain while demonstrating instability in the joint; this was the most prominent physical finding in these patients. Eleven patients (13 feet) had an excellent result. Seven patients (seven feet) had a fair result, but they complained only of mild and occasional pain at the joint on exertion. Although difficult to quantify, it appears that postoperative stiffness in the joint provided some of the joint stability seen in our patients. The flexor tendon transfer appears to be a satisfactory method to treating the unstable metatarsophalangeal joint and of relieving patients' pain, but may not, however, restore a normal alignment of the second toe. Correction of other forefoot deformities as hallux valgus and hammertoes may also be important in restoring metatarsophalangeal stability.
第二跖趾关节不稳定可能会导致前足疼痛。18例患者（20足）接受了长屈肌腱转移至近节趾骨基底伸侧的手术，作为稳定该疼痛关节的主要术式。大多数患者伴有拇外翻畸形，也需要进行矫正，因为该畸形要么也有症状，要么妨碍了第二趾的充分复位。13足显示第二跖趾关节跖板破裂，这些关节似乎是垂直不稳定的原因。然而，所有足在临床检查时均显示关节不稳定。垂直应力试验几乎总能在显示关节不稳定的同时再现患者的疼痛；这是这些患者最突出的体格检查发现。11例患者（13足）效果极佳。7例患者（7足）效果尚可，但他们仅在活动时抱怨关节有轻度且偶尔的疼痛。虽然难以量化，但似乎关节术后僵硬为我们的患者提供了一定的关节稳定性。屈肌腱转移似乎是治疗不稳定跖趾关节和缓解患者疼痛的一种令人满意的方法，然而，可能无法恢复第二趾的正常对线。矫正其他前足畸形，如拇外翻和锤状趾，对于恢复跖趾关节稳定性也可能很重要。
