• 1.

    DeOrio, JK . :Claw toe. EMedicine from WebMD .Updated February 28, 2009. Available at: http://emedicine.medscape.com/article/1232559-overview. .Accessed December 6, 2010.

    • Search Google Scholar
    • Export Citation
  • 2.

    Alvine, FG and KL Garvin. :Peg and dowel fusion of the proximal interphalangeal joint. .Foot Ankle 1::90. ,1980. .

  • 3.

    Cahill, BR and DE Connor. :A long-term follow-up on proximal phalangectomy for hammer toes. .Clin Orthop 86::191. ,1972. .

  • 4.

    Caterini, R, P Farsetti, U Tarantino, et al. :Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity. .Foot Ankle Int 25::256. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Conklin, MJ and RW Smith. :Treatment of the atypical lesser toe deformity with basal hemiphalangectomy. .Foot Ankle Int 15::585. ,1994. .

  • 6.

    Coughlin, MJ and RA Mann. : “Lesser Toe Deformities. ,” inSurgery of the Foot and Ankle, ,7th Ed. , Vol1:, edited byCoughlin, MJ and RA Mann. , p320. ,Mosby. ,St. Louis. ,1999. .

    • Search Google Scholar
    • Export Citation
  • 7.

    Myerson, MS and HG Jung. :The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. .Foot Ankle Int 26::675. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Newman, RJ and JM Fitton. :An evaluation of operative procedures in the treatment of hammer toe. .Acta Orthop Scand 50::709. ,1979. .

  • 9.

    O’Kane, C and T Kilmartin. :Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases. .Foot Ankle Int 26::320. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Gallentine, JW and JK DeOrio. :Removal of the second toe for severe hammertoe deformity in elderly patients. .Foot Ankle Int 26::353. ,2005. .

  • 11.

    Arnold, H . :Lesser toe deformities: definition, pathogenesis, and options for surgical correction [in German]. .Orthopade 34::758. ,2005. .

  • 12.

    Stroup, DF, JA Berlin, SC Morton, et al. :Meta-analysis of observational studies in epidemiology: a proposal for reporting. .JAMA 283.:2008. ,2000. .

    • Search Google Scholar
    • Export Citation
  • 13.

    Pyper, JB . :The flexor-extensor transplant operation for claw toes. .J Bone Joint Surg Br 40::528. ,1958. .

  • 14.

    Parrish, TF . :Dynamic correction of clawtoes. .Orthop Clin North Am 4::97. ,1973. .

  • 15.

    Barbari, SG and K Brevig. :Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. .Foot Ankle 5::67. ,1984. .

  • 16.

    Biyani, A, DA Jones, and JM Murray. :Flexor to extensor tendon transfer for curly toes. .Acta Orthop Scand 63::451. ,1992. .

  • 17.

    Gazdag, A and A Cracchiolo. :Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. .Foot Ankle Int 19::137. ,1998. .

  • 18.

    Burleigh, W, GS Gold, RM Jex, et al. :Flexor digitorum longum tendon transfer. .JAPMA 83::244. ,1993. .

  • 19.

    Coughlin, MJ . :Second metatarsophalangeal joint instability in the athlete. .Foot Ankle Int 14::309. ,1993. .

  • 20.

    Kuwada, GT . :A retrospective analysis of modification of the flexor tendon transfer for correction of hammertoe. .J Foot Surg 27::57. ,1988. .

    • Search Google Scholar
    • Export Citation
  • 21.

    Coughlin, MJ . :Subluxation and dislocation of the second metatarsophalangeal joint. .Orthop Clin North Am 20::535. ,1989. .

  • 22.

    Thompson, FM and JT Deland. :Flexor tendon transfer for metatarsophalangeal instability of the second toe. .Foot Ankle Int 14::385. ,1993. .

  • 23.

    Haddad, SL, RC Sabbagh, S Resch, et al. :Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity. .Foot Ankle Int 20::781. ,1999. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Mendicino, RW, TK Statler, KR Saltrick, et al. :Predislocation syndrome: a review and analysis of eight patients. .J Foot Ankle Surg 40::214. ,2001. .

  • 25.

    Myerson, MS and H Jung. :The role of the flexor to extensor transfer in correcting metatarsophalangeal joint instability of second toe. .Foot Ankle Int 26::675. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Steensman, M, M Jabara, JG Anderson, et al. :Flexor longus tendon transfer for hallux claw deformity and vertical instability of the metatarsophalangeal joint. .Foot Ankle Int 27::689. ,2006. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Ozdolop, S, KM Mathew, M McClelland, et al. :Modified Girdlestones-Taylor procedure for claw toes in spinal cord injury. .Spinal Cord 44::787. ,2006. .

  • 28.

    Boyer, ML and JK DeOrio. :Transfer of the flexor digitorum longus for the correction of leeser-toe deformities. .Foot Ankle Int 28::422. ,2007. .

  • 29.

    Bouché, RT and EJ Heit. :Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe, sagital plane instability of the lesser metatarsophalangeal joints: preliminary observations. .J Foot Ankle Surg 47::125. ,2008. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Egger, M, G Davey-Smith, M Schneider, et al. :Bias in meta-analysis detected by a simple, graphical test. .BMJ 315::629. ,1997. .

  • 31.

    Taylor, RG . :The treatment of clawtoes by multiple transfers of flexor into extensor tendons. .J Bone Joint Surg Br 33::539. ,1951. .

  • 32.

    Cooper, PS . : “Disorders and Deformities of the Lesser Toes. ,” inFoot and Ankle Disorders. , Vol1:, edited byMyerson, MS. , p308. ,WB Saunders Co. ,Philadelphia. ,2000. .

    • Search Google Scholar
    • Export Citation
  • 33.

    Caterini, R, P Farsetti, U Tarantino, et al. :Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity. .Foot Ankle Int 25::256. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Kadel, NJ, EA Donaldson-Fletcher, ST Hansen, et al. :Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux. .Foot Ankle Int 16::1021. ,2005. .

    • Crossref
    • Search Google Scholar
    • Export Citation

Meta-analysis of Flexor Tendon Transfer for the Correction of Lesser Toe Deformities

Marta E. Losa Iglesias Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain.

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Ricardo Becerro de Bengoa Vallejo Escuela Universitaria Enfermeria, Fisioterapia, y Podologia, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

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Kevin T. Jules Department of Surgical Sciences, New York College of Podiatric Medicine, New York, NY.

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Michael J. Trepal Department of Surgical Sciences, New York College of Podiatric Medicine, New York, NY.

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Background:

Transfer of the flexor digitorum longus tendon is one of the surgical techniques described to treat lesser toe deformities. A global analysis of the benefits of this procedure has not been presented in the literature to date. The aim of this meta-analysis was to evaluate the clinical benefit of transfer of the flexor digitorum longus tendon regarding patient satisfaction.

Methods:

A reviewer formally trained in meta-analysis abstraction techniques searched several databases to identify relevant published studies. Initially, 203 citations were identified and evaluated for relevance. Abstract screening produced 112 articles to be read in their entirety, of which 17 articles studying 515 procedures with a mean ± SD follow-up of 54.21 ± 20.64 months met all of the inclusion criteria necessary for analysis.

Results:

Overall crude patient satisfaction after flexor digitorum longus tendon transfer was 86.7% (95% confidence interval, 81.7%–90.5%). A low grade of heterogeneity across studies (Q = 24.458, I2 =34.583, P = .080) and no influence of the individual studies on overall estimation were found. When adjusting for higher-quality prospective studies, overall patient satisfaction increased to 91.8%, although it did not reach statistical significance. Additional a priori sources of heterogeneity (age, sex, studies with <3 years of follow-up, percentage of patients lost to follow-up, and year of publication) were evaluated by subgroup analysis and meta-regression, but no statistical significance was found. This adjustment also significantly decreased heterogeneity across studies (crude Q = 24.458, high-quality studies Q = 1.504).

Conclusions:

Regarding patient satisfaction, this comprehensive analysis provides supportive evidence of the clinical benefit of flexor digitorum longus tendon transfer. (J Am Podiatr Med Assoc 102(5): 359–368, 2012)

Corresponding author: Marta E. Losa Iglesias, PhD, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcon, Madrid 28922, Spain. (E-mail: marta.losa@urjc.es)