TRANSVERSE INCISION FOR LESSER METATARSOPHALANGEAL EXPOSURE. A WORKHORSE INCISION FOR THE FOREFOOT

Abstract

Introduction Exposure of the lesser metatarsophalangeal (MTP) joints is needed for many procedures e.g. forefoot arthroplasty and multiple Weil-type osteotomies. Traditionally collateral incisions and plantar incisions have been described. However exposure using these is often difficult and inadequate in the presence of rheumatoid arthritis (RA) and associated deformities. Transverse incisions offer excellent exposure, extensibilty, versatility and improved range of movements with decreased neurovascular compromise. Aesthetic wound healing is common. We describe our results following the use of a curved transverse incision for the Mann-Thompson type of arthroplasty and multiple Weil osteotomies. A single incision was used to expose all lesser MTP joints.

Method A total of 34 consecutive patients with either procedure were included, comprising 52 feet including 18 bilateral forefoot arthroplasty and 10 multiple Weil osteotomies. All patients were followed up for 12 months. A questionnaire was completed for each patient at conclusion of surgery, and then at 6 and 12 months. Ease of exposure, visualisation of target areas, wound healing, neurovascular complications and average range of movement were assessed. Four surgeons were involved in the study: one consultant, one NT middle grade, and two specialist registrars.

Results Three minor wound healing complications were noted, with no need for repeat surgery. No neurovascular complications were noted, cosmesis was good-to-excellent in all, a global range of movement of 30 degrees was achieved in 95%. Ease of exposure and visualisation of the target area was good-to-excellent in all patients. All surgeons reported satisfaction with the approach and rated it superior to the collateral and plantar incisions.

Conclusion We believe that this represents excellent results in this difficult group of patients. The curved transverse incision is a workhorse incision for the lesser MTP joints.