Prevalence and Associates of Foot Deformities among Patients with Diabetes in Jordan

Objectives: To determine the prevalence of, and factors associated with, people with foot deformities, among patients with diabetes in Jordan. Methods: A cross-sectional study was conducted on 1000 diabetic participants recruited from the National Center for Diabetes, Endocrinology, and Genetics in Jordan. Participants had their feet clinically examined to detect the following foot deformity outcomes: Hallux valgus, claw/hammer toe, prominent metatarsal heads, limited joint mobility, pes cavus, Charcot foot, and amputations. Sociodemographic and health variables were also collected from participants’ interviews, medical records, or clinical examination. Logistic regression was used to analyse associations between variables and each foot deformity outcome. Results: Of the 1000 diabetic patients: Hallux valgus was found in 17.4%, claw\hammer toe in 16%, prominent metatarsal head in 14.2%, limited joint mobility in 9.4%, pes cavus in 3.2%, Charcot foot in 2.1%, and amputations in 1.7%. Hallux valgus was associated with gender (p=0.012), age (p<0.01) and shoe choices (p=0.031); claw\hammer toe was associated with age (p=0.04), retinopathy (p<0.001), sensory and painful neuropathy (p<0.001); limited joint mobility was associated with age only (p=0.001); Charcot foot was associated with glycemic control (p=0.016), hypertension (p<0.000), sensory neuropathy (p<0.001), and painful neuropathy (p<0.001); and, amputations were associated with duration of diabetes (p<0.043), sensory neuropathy (p=0.001), and painful neuropathy (p=0.001). Conclusion: Prevalence of different foot deformities in Jordan variedbetween 1.7% - 17.4%. Sociodemographic factors such as age, gender and shoes choices or presence of diabetes-related microvascular complications (neuropathy and retinopathy) or hypertension were independently associated with foot deformities among the Jordanian diabetic population.

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

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.

Floating toe

Category: Midfoot/Forefoot Introduction/Purpose: The Weil osteotomy (WO) is frequently used for treating metatarsalgia and metatarsophalangeal (MTP) instability. Nevertheless, it presents complications, being the floating toe the most frequent one. A modification has been proposed to decrease the beforementioned complication, removing a slice from the osteotomy (modified Weil osteotomy, MWO). Additionally, it has been proposed that stabilizing the toe interphalangeal joints when treating hammer toes may contribute to decrease the floating toe complication, given that all flexors contribute to MTP flexion. The objective of this research is to describe complications and functional score in patients operated with MWO with and without interphalangeal stabilization. Methods: 110 patients (250 toes) treated for metatarsalgia and hammer toe deformity were retrospectively collected and prospectively followed for 66 months (SD 15). 2 groups were studied, 45 adults with isolated MWO and 65 adults with MWO with toe stabilization. Average age 55. Patients with Diabetes, previous surgeries and infections were excluded. LEFS, AOFAS and satisfaction index were recorded. A physical examination looking for floating toe, MTP instability and metatarsalgia was performed. Statistical analysis included logistic regression spearmen correlation test, Mann-Whitney test and student T test. Results: LEFS and AOFAS scores were 70 and 73 respectively, with no differences between patients operated with isolated MWO or with toe stabilization. Satisfaction index average result was “minor reservations”. Floating toe incidence was 24%, with no difference between groups. There was no difference in functional scores and satisfaction index if floating toe was present or absent. There was no correlation between functional scores and satisfaction index. Metatarsalgia was present in 31% of patients, and there is a direct correlation of floating toe occurrence and pain (4 times more chance to have pain). Conclusion: There was no clinical significant consequence of floating toe on LEFS, AOFAS or satisfaction. There was no difference in complication rate, functional scores and patient satisfaction if the interphalangeal joint was fixed or not. Although floating toe didn’t influence on functional scores, it was associated with pain. It can be suggested that the scores utilized were not able to detect the negative influence of floating toe on every patient. The high prevalence of floating toe using the MWO should make us look for additional factors which we may be overlooking when treating metatarsalgia, such as plantar plate damage.