Name of the Procedure:

Arthrodesis with Extensor Hallucis Longus Transfer to First Metatarsal Neck, Great Toe, Interphalangeal Joint (e.g., Jones Type Procedure)

Summary

This surgical procedure involves fusing the joint in the big toe (great toe) and transferring the extensor hallucis longus (EHL) tendon to the first metatarsal neck. This helps to address deformities and improve the alignment and function of the foot.

Purpose

The procedure is primarily used to correct deformities and stabilize the great toe. It aims to reduce pain, improve alignment, and restore functionality for individuals with certain types of toe deformities or instability.

Indications

• Severe toe deformities
• Instability of the great toe joint
• Arthritic conditions affecting the great toe
• Non-responsive to conservative treatments Patients who have persistent pain, recurrent toe dislocations, or severe deformities that impact daily activities may be candidates for this procedure.

Preparation

• Patients may be instructed to fast from midnight before the day of surgery.
• Pre-operative blood tests and imaging studies, such as X-rays or MRI, are typically required.
• Medication adjustments may be necessary, including stopping certain blood thinners.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered for patient comfort.
2. Incision: A surgical incision is made over the first metatarsophalangeal joint.
3. Joint Preparation: The great toe joint is exposed, and the joint surfaces are prepared for arthrodesis (fusion).
4. Tendon Transfer: The EHL tendon is identified, detached, and rerouted to the neck of the first metatarsal.
5. Fixation: Surgical screws or plates may be used to stabilize the fused joint and secure the tendon transfer.
6. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure generally takes about 1-2 hours, depending on the complexity of the deformity and other factors.

Setting

The procedure is performed in a hospital or surgical center, typically as an inpatient surgery.

Personnel

• Orthopedic surgeon and surgical assistants
• Anesthesiologist
• Operating room nurses and technicians

Risks and Complications

• Infection
• Nerve damage
• Nonunion or delayed healing of the fusion
• Issues with tendon transfer
• Blood clots
• Anesthesia-related risks

Benefits

• Reduction in pain
• Improved toe alignment and foot function
• Enhanced ability to perform activities of daily living
• Long-term stability of the great toe

Recovery

• Initial recovery involves wearing a cast or boot and keeping weight off the affected foot.
• Physical therapy may be beneficial for regaining strength and mobility.
• Full recovery and return to normal activities can take several months.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Non-surgical treatment options such as physical therapy, orthotics, and medications.
• Other surgical procedures like osteotomy or joint replacement may be considered.
• Each alternative has specific pros and cons, with varying degrees of effectiveness.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, pain management strategies will be employed to ensure comfort. The patient may experience initial swelling, bruising, and limited mobility, which will gradually improve with adherence to recovery protocols.

Pain and swelling are typically managed with medications, elevation of the foot, and the use of ice packs.