Treat with IV antibiotics and excise any infected tissue and lavage the joint. Test biopsy specimen to help identify organism and tailor antibiotics to suit. You may need to do a 2-stage revision with antibiotic beads/spacer.
Recommend rest with elevated foot to aid healing.
Fuse the joint with suitable bone graft supported with a rigid MTP plate.
Re-align the joint by re-positioning the Phalanx with or without the use of an anatomic meniscus to correct up to a 3° valgus or varus mal-alignment.
In the event of a developing valgus deformity, that deformity must be corrected whilst endeavouring to preserve the ROTOglideTM. This could be achieved via a proximal correcting osteotomy of the first metatarsal or a Lapidus procedure correcting the entire first ray. It may also be necessary to adjust the angle of proximal phalanx. This can be achieved via angled or skewed cut of the proximal phalanx.
The crucial point is that the position of both sesamoids must be sit behind the metatarsal head. They should be screened by the metatarsal head and not be visible on a frontal x-ray. This will ensure that the tendons are seated in their sulci.
Soft tissue management and use of an 8 mm meniscus or
Re-position Phalanx and with or without the use of a thicker meniscus.
Soft tissue balancing using a mini-internal brace.
Soft tissue release of FHB, MT–Sesamoid joint, excision of medial sesamoid.
Replace with thinner meniscus or
Re-position Phalanx and use with thinner Phalanx
If all else fails...
Revise with a larger or custom ROTOglideTM
Custom implants will require ordering in advance in accordance with an agreed protocol.
This is the only total MTP joint implant that allows constant adaption of the great toe towards the ground surface under stable conditions due to the rotation between the phalangeal implant and the meniscus.
Professor Hakon Kofoed
ROTOglide offers a practical and well-tested alternative to fusion for those patients wishing to maintain movement in their arthritic great toe.
Mr Patrick Laing & Mr. Chris Walker
The only total joint replacement with positive evidence regarding function and clinical outcome
Prof. Dr. med. Martinus Richter
Get in touch and we can help set you on the right path.