Updated: 6/29/2013

Dorsomedial Approach to MTP Joint of Great Toe

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Introduction
  • 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







 
Preparation
  • 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 
  
Technique
  • 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
  
Dangers
  • 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
  
 

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