Indications for Elective MTP Joint Disarticulation in Adults

Background: There are a variety of reasons that physicians propose and/or patients choose to undergo elective metatarsophalangeal (MTP) joint disarticulation. Most often the objective is to provide pain relief and improve quality of life. Less frequently this is undertaken for life saving reasons. Our goal was to examine patients who underwent this procedure over an 18-year period and compare our indications and technique with those cited in the academic literature.

Methods: A review of patients proposed for this procedure at Toronto Western Hospital was conducted. Data collected from 11 patients over an 18-year period from 2000-2018 included: age, gender, laterality, affected toes, comorbidities, treatments/surgery provided, surgical outcome, pathology and rationale.

Results: There were seven women (mean age 61; SD 16) and four men (mean age 60; SD 6.1). An equal number of patients presented with right (45%) and left foot (45%) pathologies, while 1 patient was affected bilaterally (10%). 11 MTP joint disarticulations were performed in 7 patients (63%) for reasons that will be presented. Two patients booked for surgery declined or cancelled. Two patients’ toes auto-amputated as a result of diabetic ulcers/gangrene and their removal was performed in the Outpatient Department.

Conclusions: There are many factors to consider when determining if an elective MTP joint disarticulation should be performed. A Table listing the absolute and relative indications for MTP disarticulation was developed and is presented here alongside our indications. In this review, no major complications resulted from those who underwent the procedure. Future research should determine if there is an optimum technique for elective MTP disarticulation. Further discussion should address whether a patient’s request for elective disarticulation is sufficient to justify surgery.