Elsevier

The Journal of Foot and Ankle Surgery

Volume 48, Issue 1, January–February 2009, Pages 61-69
The Journal of Foot and Ankle Surgery

Case report
Reconstruction of the First Metatarsophalangeal Joint Following Post-cheilectomy Avascular Necrosis of the First Metatarsal Head: A Case Report

https://doi.org/10.1053/j.jfas.2008.10.002Get rights and content

Avascular necrosis of the first metatarsal head is a well-known, albeit rare, complication associated with hallux abductovalgus surgery. In this report, we describe the case of a 51-year-old male who developed osteonecrosis of the first metatarsal head 1 year after undergoing an isolated cheilectomy for the treatment of hallux rigidus. To our knowledge, this is the first published report of osteonecrosis following isolated cheilectomy used for the treatment of hallux rigidus. A bone graft substitute with undifferentiated stem cells was used to pack the medullary canals of the first metatarsal and the proximal phalanx. A section of autogenous calcaneal graft was used to perform a bone block distraction arthrodesis of the first metatarsophalangeal joint. Level of Clinical Evidence: 4

Section snippets

Case Report

A 51-year-old male with no significant past medical history presented to the senior author (T.A.B.) with a complaint of pain and swelling localized to the first MTPJ of his left foot. The patient reported having undergone a cheilectomy procedure performed by another surgeon approximately 12 months prior. The clinical examination revealed increased girth localized to the first MTPJ, and there was no evidence of motion at the joint. Clinical notes and the operative report were obtained from the

Discussion

The blood supply to the first metatarsal has been elucidated in the scientific literature. Shereff et al (7) demonstrated the extraosseous and intraosseous blood supply to the first metatarsal and MTPJ by means of vascular injection techniques in cadaveric specimens. The extraosseous supply arises from the first dorsal metatarsal artery, the first plantar metatarsal artery, and the superficial branch of the medial plantar artery. The intraosseous blood supply includes a nutrient artery that

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      2015, Foot and Ankle Clinics
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      Thermann and Becher2 support a more aggressive soft-tissue release, passing a McGlamry elevator proximally along the plantar aspect of the first metatarsal to achieve subperiosteal release of the joint capsule, sesamoid bones, and short flexor muscles, before using a scalpel to release the plantar phalangeal insertions of the joint capsule and the short flexor muscles. Caution should be exercised, however, as excessive periosteal stripping carries a risk of avascular necrosis to the metatarsal head.9 To complement cheilectomy and improve apparent joint motion, a dorsal closing wedge osteotomy of the proximal phalanx10,11 or the first metatarsal12 can be added.

    • Pain after cheilectomy of the first metatarsophalangeal joint. Diagnosis and management

      2014, Foot and Ankle Clinics
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      Avascular necrosis of the metatarsal head is a rare complication of cheilectomy. Brosky and colleagues26 described the case of a 51-year-old man treated 1 year after isolated cheilectomy for hallux rigidus with an arthrodesis using calcaneal bone graft and a bone substitute with stem cells. To minimize the possibility of a poor result after cheilectomy, patients should be screened clinically and radiographically to ensure that cheilectomy is the appropriate procedure.

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      2013, Foot
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      It causes the cellular death of bone and when a joint is affected, it has the potential to cause complete collapse and osteoarthritis. This can be regarded as a poor outcome if it occurs as a complication of surgery [1–10]. AVN can arise spontaneously in known anatomical locations such as the second metatarsal head (Freibergs disease).

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    Financial Disclosure: None reported.

    Conflicts of Interest: None reported.

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