These three cases reveal the complete development of metatarsalhead deformity due to (1) sesamoid insufficiency or (2) weight-bearing directly on the first metatarsal head with subsequent minute repeated traumata, resulting in an aseptic necrosis.
It is not within the scope of our paper to include the therapy, but, in our opinion, it is the logical conclusion that, when these cases are seen early, a protective mechanism should be applied to relieve strain and stress of dorsiflexion in the first metatarsal joint. The metatarsal bar would be of a distinct advantage, as in each of our cases a varying degree of hallux rigidus was present. Of these three patients, two have responded well to a shoe adjustment,-namely, the addition of a bar, one-quarter of an inch thick. In the remaining case, in which the hallux rigidus was so marked that regardless of the bar the patient still had distress, a bilateral partial phalangectomy of the proximal phalanx was performed, with definite improvement.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.