Predislocation

 

PREDISLOCATION SYNDROME
(Synovitis)
By:  Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

 

PROBLEM:

  • Drifting of the second toe towards the big toe, causing pain, deformity and early development of an overlapping second toe over the big toe.

CAUSE:

  • Trauma to the second toe joint causing inflammation to that region.
  • Inflammation of the nerves on the ball of the foot (neuroma).
  • Long second toe or second metatarsal, causing a hammertoe and excess stress on the ball of the foot.
  • Weakness or tearing of the ligament holding the second toe straight.
  • Pressure on the second toe from a bunion deformity.
  • Pressure on the second toe due to a crooked big toe (hallux deformity).

SIGNS & SYMPTOMS:

  • Visible space between second and third toe while weightbearing.
  • Pain to the second toe that increases with walking.
  • Difficulty walking barefoot and unable to wear heels.
  • Drifting of the second toe towards or over the first toe (overlapping toe).
  • Hammertoe of the second toe.
  • Neuritis (inflamed nerve causing numbness, burning and tingling).
  • Associated with bunion deformity and/or crooked big toe.
  • Swelling of the second toe and/or ball of the foot.
  • Callus (hard skin) on the ball of the foot.

TREATMENT:

  • Anti-inflammatories to decrease inflammation and stiff-sole shoes to prevent toe bending.
  • Taping of the toes to lessen the pain and deformity.
  • Surgery to realign the joint and possibly remove the nerve to achieve full recovery.

PROGNOSIS:

  • Excellent with regard to eliminating the pain and deformity.  The earlier the treatment, the better the long-term prognosis. 

Intraop Pics of Hammertoe correction

This patient had a bunion that is corrected. Also, the second toe overlapped the big toe. We have released the medial side to stop the pull towards the big toe. Below, we are putting in sutures on the lateral side to aid correction and maintenance of the reduction of the second toe joint.

After the repair of the 2nd MPJ, we perform a PIPJ Fusion and temporarily pin the second toe across the MPJ to allow healing of all bone and soft tissue. This pin is taken out in the office at approximately 6 wks.

The below patient had PDS and a long second metatarsal that caused pain. In the following pics, a Weil osteotomy is performed to correct the 2nd toe joint

The second metatarsal is prepared for the osteotomy below

The Osteotomy has been made and the metatarsal head is shifted 3-4 mmm back and temporarily pinned. The overlap on the top can be seen prior to removal and recontouring the head.

The osteotomy is then permanently fixed with 2 screws

Below, Pics of fixation of Weil Osteotomy

Weil osteotomy has been made and the 2 pins are temporarily fixating the second metatarsal head. The metatardsal head is shifted back 3-4 mm as can be seen by the lip of bone at the top.

The blue and gold screw are permanently fixing the bone and the 2 wires are then removed.

Final view of the Weil osteotomy. Due to the displacement and drift of the toe, the metatarsal head was shortened and shifted 2 mm to the side as can be seen by the ridge of bone to the left.