Updated: 6/29/2013

Dorsomedial Approach to MTP Joint of Great Toe

Review Topic
  • Indications
    • excision of
      • metatarsal head
      • proximal phalanx
      • metatarsal exostosis
    • distal metatarsal osteotomy
    • soft-tissue correction of hallux valgus
    • 1st MTP arthrodesis
    • dorsal wedge osteotomy for hallux rigidus
    • MTP joint replacement
Internervous Plane
  • None
    • the bone is subcutaneous

  • Anesthesia
    • general
    • block
  • Positioning
    • supine with bump under ipsilateral hip
  • Tourniquet
    • placed on middle of thigh or calf
    • exsanguinate limb by elevation for 3-5 minutes 
  • Incision
    • 5-6 cm incision medial and parallel to tendon of extensor hallucis longus (EHL)
    • start 2-3 cm proximal to MTP joint
    • extend distally to the proximal interphalangeal joint
  • Superficial dissection
    • incise deep fascia in line with incision
    • retract EHL laterally
    • retract dorsal digital branch of the medial cutaneous nerve laterally
  • Deep dissection
    • make a U-shaped incision through joint capsule
      • base of the flap should attach at base of proximal phalanx
  • Tendons
    • extensor hallucis longus
      • lies in lateral edge of wound
      • retract laterally
    • flexor hallucis longus
      • lies in groove on the plantar surface of the proximal phalanx
      • may be injured during subperiosteal stripping
  • Nerves
    • dorsal digital branch of the medial cutaneous nerve

Please rate topic.

Average 5.0 of 2 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note