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.

Finite-element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of claw toe deformity

2009 ◽  
Vol 42 (11) ◽  
pp. 1697-1704 ◽  
Author(s):  
Alberto García-González ◽  
Javier Bayod ◽  
Juan Carlos Prados-Frutos ◽  
Marta Losa-Iglesias ◽  
Kevin T. Jules ◽  
...  
Keyword(s):  
Finite Element ◽  
Finite Element Simulation ◽  
Tendon Transfer ◽  
Flexor Digitorum Longus ◽  
Claw Toe ◽  
Element Simulation ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum ◽  
Toe Deformity

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.

Stress at the Second Metatarsal Bone After Correction of Hammertoe and Claw Toe Deformity

2013 ◽  
Vol 103 (4) ◽  
pp. 260-273 ◽  
Author(s):  
Javier Bayod ◽  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Manuel Doblaré
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Tendon Transfer ◽  
Metatarsal Bone ◽  
Element Analysis ◽  
Claw Toe ◽  
Compressive Stresses ◽  
Second Metatarsal ◽  
Flexor Digitorum ◽  
Toe Deformity

Background: We used finite element analysis to evaluate three techniques for the correction of hammertoe and claw toe deformities: flexor digitorum longus tendon transfer (FDLT), flexor digitorum brevis tendon transfer (FDBT), and proximal interphalangeal joint arthrodesis (PIPJA). Methods: We performed a finite element analysis of FDLT and FDBT compared with PIPJA of the second toe using multislice computed tomography and 93 tomographic images of the foot obtained in a healthy 36-year-old man. Results: The PIPJA showed a significantly higher increase in traction and compressive stresses and strain at the medial aspect of the shaft of the second metatarsal bone compared with FDLT or FDBT (P < .01). Mean ± SD compressive stresses increased to −4.35 ± 7.05 MPa compared with the nonsurgical foot (−3.10 ± 4.90 MPa). It can, therefore, be hypothesized that if PIPJA is used to correct the hammertoe and claw toe deformities, it could also increase traction and compressive stresses and strain in the metatarsals during running and other vigorous activities. Conclusions: There is a biomechanical advantage to performing FDLT or FDBT instead of PIPJA to surgically treat a hammertoe or claw toe deformity. In addition, tensile strain at the dorsal aspect of the second metatarsal bone when performing PIPJA increases the risk of metatarsalgia or stress fracture in patients at risk. (J Am Podiatr Med Assoc 103(4): 260–273, 2013)

TREATMENT OF CONGENITAL SWAN NECK DEFORMITY WITH DYNAMIC TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT

2001 ◽  
Vol 26 (2) ◽  
pp. 165-167 ◽  
Author(s):  
V. SMRÈKA ◽  
I. DYLEVSKÝ
Keyword(s):  
Tendon Transfer ◽  
Tendon Graft ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Superficialis ◽  
Middle Phalanx ◽  
Flexor Digitorum ◽  
Swan Neck Deformity

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

Single Longitudinal Dorsal Incision Approach to Transfer the Flexor Digitorum Longus Tendon Between the Flexor Digitorum Brevis Hemitendons

2013 ◽  
Vol 103 (5) ◽  
pp. 430-437 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Miguel Fuentes Rodriguez ◽  
Fermín Viejo Tirado
Keyword(s):  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Proximal Interphalangeal Joint ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Longitudinal Incision ◽  
Novel Approach ◽  
Vascular Compromise ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons. (J Am Podiatr Med Assoc 103(5): 430–437, 2013)

Hammer Toe Correction by Arthrodesis of the Proximal Interphalangeal Joint Using a Cortical Bone Allograft Pin

2002 ◽  
Vol 92 (10) ◽  
pp. 563-569 ◽  
Author(s):  
Stephen J. Miller
Keyword(s):  
Internal Fixation ◽  
Cortical Bone ◽  
Tendon Transfer ◽  
Bone Allograft ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Longus ◽  
Hammer Toe ◽  
Freeze Dried ◽  
Flexor Digitorum

In hammer toe correction by means of digital fusion, fixation so that the bone can unite while maintaining appropriate realignment can be a challenge. Metal fixation pins can be associated with many problems and potential complications. The author presents a method of rigid internal fixation using 2.4-mm-diameter pins fashioned out of freeze-dried allogeneic cortical bone. These devices avoid most of the risks of metal pins. Proximal interphalangeal joint arthrodesis using cortical bone pins was performed on 26 toes in 18 patients with very few complications. The author concludes that use of cortical bone pins can yield successful results in most cases. The outcomes of the fusions can be further enhanced by using flexor digitorum longus tendon transfer. (J Am Podiatr Med Assoc 92(10): 563-569, 2002)

Irreducible Dislocation of the Proximal Inter-Phalangeal Joint of a Finger

1998 ◽  
Vol 23 (2) ◽  
pp. 252-252 ◽  
Author(s):  
J. KUNG ◽  
S. TOULIOPOLIS ◽  
D. CALIGIURI
Keyword(s):  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Superficialis ◽  
Flexor Digitorum

We report a patient with an irreducible dislocation of the proximal interphalangeal joint which was due to entrapment of the head of the proximal phalanx in the opening of the flexor digitorum superficialis tendon just proximal to its chiasma.

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