05/03/2013    

QUERIES (CLINCAL)

Query: Post-Keller Complication

The patient is a 54 year-old woman who wears orthotics. In 2011, she successfully underwent a Keller procedure (interpositional arthroplasty) for a moderate HAV with 1st MTP joint DJD. There is no pain or other problems in this area. What started as a mild contracture deformity of the 2nd toe has developed into a multi-planar deformity of the toe with pain and swelling at the 2nd MTP joint which has not responded well to treatment. Her best relief was through the use of a Medrol Dose Pack. Her arthritic profile was negative.

Post-Keller Complication

The Keller procedure likely increased pressure on the 2nd MTP joint with a subluxation/predislocation now evident. What is surprising is the rapidly advanced DJD with loss of joint space and bone cyst formation in the 2nd met head. I am concerned about the long-term integrity of the 2nd met head if I do not specifically address the bone cyst formation. I would prefer to leave her with an intact met head for weight-bearing, if possible. Suggestions?

Gregory Caringi, DPM, Lansdale, PA