Brunner type incision was made over the second toe. Sharp dissection was carried down through the subcutaneous tissue. The second MTP joint, as well as PIP joint and DIP joint were all opened. The MTP head was then débrided out of a large exostosis over the superior aspect. It was at this point that a silastic implant was noted to be in the joint. The silastic implant was removed. A synovectomy of the MTP joint was performed, including curetting the canals. Once this was completed, attention was turned to the PIP joint, where the extensor tendon was divided. The distal end of the proximal phalanx was resected. The base of the middle phalanx also was resected, and complete extension was still obtained. The dissection was carried out to the DIP joint, where the distal end of the middle phalanx was resected. Attention was turned back to the second metatarsal head at this point. Using oblique osteotomy, the second metatarsal head was excised using a saw and bone biter.

The area was débrided of any other additional synovitis or inflammation.

At this point, a 0.062 K-wire was driven out the proximal phalanx, out the distal end of the toe. With the DIP, PIP joints reduced, and the MTP joint in well alignment, the K-wire was driven back into the mid foot into the base of the second metatarsal.


remove implant??