AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Great Toe Arthroscopy-Richard Ferkel, M.D.

Great Toe Arthroscopy-Richard Ferkel, M.D.

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This document provides a comprehensive overview of arthroscopy procedures for the great toe, focusing on anatomy, indications, techniques, instrumentation, and specific joint pathologies, as well as talonavicular and second metatarsophalangeal (MTP) joint arthroscopy.<br /><br />Anatomically, the first MTP joint is a chondroloid joint bearing about 50% of body weight during normal gait and supporting twice the load of lesser toes, making it prone to injury. Key structures include the extensor hallucis longus and brevis dorsally, sesamoid complex plantarly, and various nerves and arteries supplying the area.<br /><br />Indications for great toe arthroscopy are therapeutic and include hallux rigidus (degenerative joint disease), synovitis, loose bodies, chondromalacia, arthrofibrosis, sesamoid fractures or sesamoiditis, osteochondral injuries, and gout. Arthroscopy employs small joint scopes (1.9-2.7 mm) with dorsomedial, dorsolateral, and medial portals for access.<br /><br />Techniques involve joint distension with saline, portal establishment under direct vision, and treatment such as synovectomy, chondroplasty, osteophyte resection, excision of loose bodies, and microfracture for cartilage repair. Hallux rigidus is addressed with soft tissue and osteophyte management, while sesamoid pathology requires careful medial portal use.<br /><br />Results from studies show high rates of pain relief post-arthroscopy, particularly for osteophytes and mild to moderate disease, but less efficacy in extensive degenerative joint disease. Postoperative protocols include early weight-bearing as tolerated and gradual return to activity.<br /><br />The document also details arthroscopy of the second MTP joint and talonavicular joint. Talonavicular arthroscopy is less common but useful for synovitis, debridement, and osteochondral lesions, requiring precise portal placement to avoid neurovascular injury and specialized distractors to increase joint space. A case study demonstrates successful talonavicular arthroscopy with osteochondral lesion excision and microfracture followed by bone marrow aspirate concentrate injection, resulting in full recovery.<br /><br />In summary, great toe and talonavicular arthroscopy are valuable minimally invasive techniques for various joint pathologies, demanding detailed anatomical knowledge, small joint instruments, and careful portal placement for safe and effective outcomes.

Keywords

great toe arthroscopy

first metatarsophalangeal joint

hallux rigidus

sesamoid fractures

chondromalacia

osteophyte resection

joint distension techniques

talonavicular arthroscopy

second metatarsophalangeal joint

microfracture cartilage repair