From the Guidelines
Management of subluxation of the 2nd metatarsophalangeal (MTP) joint should prioritize conservative approaches, including rest, ice, anti-inflammatory medications, and appropriate footwear modifications, before considering surgical interventions like metatarsal osteotomy or joint arthroplasty, as indicated by recent guidelines 1. The initial treatment should focus on conservative measures, including rest, ice, and anti-inflammatory medications (such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 1-2 weeks) to reduce pain and inflammation.
- Appropriate footwear modifications with metatarsal pads can help redistribute pressure away from the affected joint, reducing discomfort and promoting healing.
- Physical therapy is beneficial to strengthen the intrinsic foot muscles and improve joint stability, which can help prevent further subluxation and reduce the risk of complications like hammertoe deformity and metatarsalgia.
- Taping techniques can help maintain proper alignment of the toe, and a toe spacer or orthotic device may be prescribed to prevent further subluxation and reduce pain. For moderate cases, corticosteroid injections (such as methylprednisolone 40mg mixed with local anesthetic) can provide temporary relief, but their use should be judicious and based on individual patient needs. If conservative management fails after 3-6 months, surgical intervention may be necessary, with options including soft tissue procedures like capsular release, tendon transfers, or plantar plate repair, and bony procedures such as metatarsal osteotomy to realign the joint, as supported by recent guidelines 1. Early intervention is crucial, as chronic subluxation can lead to complications like hammertoe deformity, metatarsalgia, and transfer lesions, emphasizing the need for prompt and effective management to improve patient outcomes and quality of life.
From the Research
Management of Subluxation of 2nd MTP
The management of subluxation of the 2nd metatarsophalangeal joint (MTP) can be approached through various methods, including conservative treatment and surgical intervention.
- Conservative treatment may be attempted first, but if it fails, surgical options can be considered 2.
- Surgical goals include reducing the MTP joint and achieving a stable toe, which can be accomplished through a stepwise approach depending on the severity of the contracture, bony overlap, and deformity 2.
Surgical Options
Surgical treatment of the subluxed 2nd MTP joint has been explored in various studies, with options including:
- Flexor tendon transfer, which has been reported as a mainstay of treatment to stabilize the subluxed 2nd MTP joint 3.
- Primary repair of the plantar plate, which has been shown to be a viable alternative to flexor tendon transfer in stabilizing the 2nd MTP joint, with the advantage of addressing the pathology anatomically 3.
- Plantar plate tear repair and lateral soft tissue reefing, which can restore the normal alignment of the joint with anatomic repair 4.
Grading of Deformity
The deformity can be graded based on clinical findings and anatomic aspects of the plantar plate tears, allowing for a more tailored approach to treatment 4.
- A proposed clinical staging and anatomic grading classification combines clinical findings and anatomic aspects of the plantar plate tears to guide treatment decisions 4.
Other Considerations
While the majority of the evidence focuses on the 2nd MTP joint, it is worth noting that subluxation can occur in other joints, such as the patella, and may require different management approaches 5.