Forefoot reconstruction: Effectiveness of Stainsby operation in treating disclocated lesser toes

BackgroundDeformity of the forefoot is a common disabling problem especially in chronic rheumatoid arthritis. The most common deformities are hallux valgus and dorsally dislocated clawed lesser toes.ObjectiveThis paper assesses results of forefoot reconstruction with emphasis on the effectiveness of Stainsby's procedure in treating severely clawed lesser toes with irreducible dislocation at the metatarsophalangeal joint. The purpose of this procedure is to remove the deforming forces causing depression of the metatarsal head, and restore the dorsally displaced plantar plate of the MTP joint and the related part of the plantar fat pad to their correct position beneath the metatarsal head.MethodSeventy-four patients were operated on between 1998 and 2003. Sixty-nine patients (94 feet) were available for review at an average of 32 months (range 10–67) post surgery. American Orthopaedic Foot and Ankle Scores (AOFAS) were measured and footprints were obtained. Patients were asked about overall satisfaction and whether they would recommend the operation to a family member.ResultsEighty-nine of the 94 feet (95%) had severe or moderate pain preoperatively under the dislocated metatarsal head; only 19 (20%) had significant pain at review. Tender plantar callosities were reduced from 76 feet preoperatively (81%) to 31 feet (33%) at review, these were mainly under un-operated metatarsal heads. Footprints showed a normal loading under 63% of operated metatarsal heads. AOFAS scores were increased from a mean of 19 preoperatively to 52 at review. Residual valgus of the big toe of more than 25° persisted in 33 feet (35%). Corrective osteotomy of 44 first metatarsals resulted in significant residual valgus in 16 feet (36%).ConclusionsStainsby operation was effective in relieving pain and skin callosities from under dislocated lesser metatarsal heads, and in reducing shoe problems, but the osteotomy performed by the authors was unreliable in correcting valgus of the big toe.