Treatment of metatarsalgia based on claw toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint: Evaluation based on foot kinematics and plantar pressure distribution

2020 ◽  
Vol 26 (7) ◽  
pp. 755-762
Author(s):  
Niki M. Stolwijk ◽  
Noël L.W. Keijsers ◽  
Jantsje H. Pasma ◽  
Wandana Nanhoe-Mahabier ◽  
Jacques Duysens ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Soft Tissue Release ◽  
Foot Kinematics ◽  
Claw Toe ◽  
Plantar Pressure Distribution ◽  
Toe Deformity ◽  
Joint Evaluation

scholarly journals Minimally invasive management of dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe

2011 ◽  
Vol 1 (2) ◽  
pp. 27
Author(s):  
Mariano De Prado ◽  
Pedro-Luis Ripoll ◽  
Pau Golanó ◽  
Javier Vaquero ◽  
Nicola Maffulli
Keyword(s):  
Minimally Invasive ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Invasive Technique ◽  
Wedge Osteotomy ◽  
Invasive Approach ◽  
Fifth Toe ◽  
Toe Deformity

Several surgical options have been described to manage persistent dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe. We describe a minimally invasive technique for the management of this deformity. We perform a plantar closing wedge osteotomy of the 5th toe at the base of its proximal phalanx associated with a lateral condylectomy of the head of the proximal phalanx and at the base of the middle phalanx. Lastly, a complete tenotomy of the deep and superficial flexor tendons and of the tendon of the extensor digitorum longus is undertaken. Correction of cock-up fifth toe deformity is achieved using a minimally invasive approach.

Definitions of Hammer Toe and Claw Toe

2009 ◽  
Vol 99 (3) ◽  
pp. 194-197 ◽  
Author(s):  
Joost C.M. Schrier ◽  
Cees C.P.M. Verheyen ◽  
Jan Willem Louwerens
Keyword(s):  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Clear Definition ◽  
Literature Study ◽  
Claw Toe ◽  
Hammer Toe ◽  
Single Criterion ◽  
Pubmed Database ◽  
Definition Of

Background: Lesser toe surgery is among the most conducted interventions in general orthopedic practice. However, the definitions of hammer toe and claw toe are not uniform. The objective of this literature study is to propose clear definitions for these deformities to establish unambiguous communication. Methods: A literature search was performed in the PubMed database (May 2006). Of 81 eligible articles, 42 that stated a clear definition of hammer toe or claw toe were selected. Results: In all 35 articles in which hammer toe was clearly defined, flexion in the proximal interphalangeal joint was part of the definition. Seventeen articles (49%) defined hammer toe as a combination of metatarsophalangeal extension and proximal interphalangeal flexion. Thirteen articles showed flexion of the proximal interphalangeal joint as the single criterion. Twenty-three articles with a clear definition of claw toe were selected. Twenty-one articles (91%) showed metatarsophalangeal extension as part of the claw toe deformity. Twelve articles (52%) regarded metatarsophalangeal extension and flexion of the proximal interphalangeal and distal interphalangeal joints as the essential characteristics. Seven articles described a claw toe as metatarsophalangeal extension with flexion in the proximal interphalangeal joint. Conclusions: There are variations in the definitions of lesser toe deformities in the literature. We propose that extension of the metatarsophalangeal joint is the discriminating factor and essential characteristic for claw toe. Claw toe and hammer toe should be characterized by flexion in the proximal interphalangeal joint, which is the single criterion for a hammer toe. The flexibility of these joints could be a basic factor in discriminating between these deformities. The development of these deformities should be regarded as a continuum in the same pathophysiologic process. (J Am Podiatr Med Assoc 99(3): 194–197, 2009)

Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren’s disease

2011 ◽  
Vol 37 (8) ◽  
pp. 722-727 ◽  
Author(s):  
J. Larocerie-Salgado ◽  
J. Davidson
Keyword(s):  
Soft Tissue ◽  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Patient Dissatisfaction ◽  
Flexion Contractures ◽  
Alternative Treatment Option ◽  
Soft Tissue Mobilization

Post-surgical outcomes in patients with Dupuytren’s disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (±7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ±5.1°; range: 5–25°) over the course of the treatment ( p < .05). Nighttime static extension splinting and soft tissue mobilization techniques appear to delay and possibly prevent the need for surgery in individuals with flexion contractures of the proximal interphalangeal joint due to Dupuytren’s disease.

scholarly journals Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902091116
Author(s):  
Rachel XY Wei ◽  
Samuel KK Ling ◽  
TH Lui ◽  
Patrick SH Yung
Keyword(s):  
Systematic Review ◽  
Surgical Complication ◽  
Deformity Correction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Complication Rates ◽  
The Novel ◽  
Claw Toe ◽  
Hammer Toe ◽  
K Wires

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.

Autogenous Bone Graft Interpositional Arthrodesis for the Correction of Flail Toe

2003 ◽  
Vol 93 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Kieran T. Mahan ◽  
Michael S. Downey ◽  
Glenn D. Weinfeld
Keyword(s):  
Bone Graft ◽  
Postoperative Management ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Autogenous Bone Graft ◽  
Autogenous Bone ◽  
Foot And Ankle ◽  
Management Protocol ◽  
Digital Surgery ◽  
Toe Deformity

Digital surgery is one of the most common types of surgery performed by foot and ankle surgeons. Flail toe is a complication that may occur after overaggressive resection arthroplasty of the proximal interphalangeal joint of the lesser toes. Correction of flail toe deformity has received little attention and has predominantly involved soft-tissue procedures. The authors’ preferred technique for the surgical correction of flail toe is to place a unicortical autogenous bone graft (harvested from the ipsilateral calcaneus) within the revised proximal interphalangeal joint of the lesser toes to create a distraction arthrodesis. This technique allows restoration of digital length, stability, and purchase. A retrospective review of 22 such procedures in 13 patients is presented, along with a literature review of other procedures and a description of the authors’ current surgical technique and postoperative management protocol. Overall success using the authors’ procedure was 82%. Complications occurred in three patients, with one of the grafts showing complete resorption and two requiring additional surgical intervention owing to nonunion and malunion of toes. (J Am Podiatr Med Assoc 93(3): 167-173, 2003)

“Pilot Hole” Technique for Interphalangeal Joint Fusion of Toes

2016 ◽  
Vol 106 (4) ◽  
pp. 305-307
Author(s):  
Nikhil Sharma ◽  
David Morley ◽  
Dev Damany
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Claw Toe ◽  
Pilot Hole ◽  
Reproducible Technique ◽  
Joint Fusion ◽  
Intramedullary Canal

Fusion of an interphalangeal joint of a lesser toe is a commonly used procedure for addressing interphalangeal joint deformities such as a hammer or a claw toe. Fusion can be achieved by insertion of an intramedullary Kirschner wire in a retrograde manner. Deviation of the Kirschner wire from the intramedullary canal into the surrounding soft tissues is common. This can render the fusion unstable and can cause painful soft-tissue irritation and early Kirschner wire loosening, resulting in an unstable nonunion with recurrence of deformity. We describe a simple and reproducible technique to assist with optimal intramedullary placement of the Kirschner wire, thereby reducing the risk of complications after interphalangeal joint fusion of a toe.

Advantages and Drawbacks of Proximal Interphalangeal Joint Fusion Versus Flexor Tendon Transfer in the Correction of Hammer and Claw Toe Deformity. A Finite-Element Study

2010 ◽  
Vol 132 (5) ◽  
Author(s):  
Javier Bayod ◽  
Marta Losa-Iglesias ◽  
Ricardo Becerro de Bengoa-Vallejo ◽  
Juan Carlos Prados-Frutos ◽  
Kevin T. Jules ◽  
...  
Keyword(s):  
Finite Element ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Delayed Union ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
The Finite Element Method ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum ◽  
Toe Deformity

Correction of claw or hammer toe deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical toe.

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