Orthopaedic MD

this procedure allows long toe flexors to behave like intrinsic muscles producing active plantar flexion at MP joints & extension at IP joint;
- indicated for flexible hammer toes and claw toes;
- inform pt that toe ischemia sometimes follows correction of this deformity;

Metatarsophalangeal joint dysfunction (MPJ) is one of the more common presentations that podiatrists see in practice. With this in mind, these authors offer pertinent pearls on the Weil osteotomy and weigh the benefits of hybrid screw fixation in facilitating improved outcomes.
By Michael Salcedo, DPM, and Michael Motyer, DPM

Pain in the second MTP with synovitis and instability was first described in 1985 by Mann et al, who considered that the instability was due to synovitis of uncertain origin, perhaps associated with impingement from hallux valgus. Several relatively small studies have elucidated this problem further.

Instability and synovitis of the lesser MTP joints is a common cause of forefoot pain. Peck et al's (2006) series of 164 patients represented 26% of the patients presenting to their clinic with metatarsalgia.

Lorimer (1993; 88) describes retracted toes as, "toes which are drawn back into a dorsiflexed position and are therefore less effective in locomotion." The retraction is specific to the metatarsophalangeal joints (MPJ). Associated phalangeal joint pathologies are common with this condition.

Lesser Toe Problems
A number of abnormalities may need to be addressed: there is almost always a hammertoe deformity
instability of the MTP joint with a partial or full thickness plantar plate tear (plain or MR arthrography, or ultrasound, can help distinguish partial from full thickness tears)
in a few patients, fixed dislocation of the MTP joint