Search Results
Background
Although Kirschner wire implantation is popular for treating toe deformities, complications frequently occur. To prevent pin-tract infection and difficult Kirschner wire extraction, several implants have been developed to improve treatment outcomes.
Methods
Patients who had undergone an interphalangeal fusion by two-component implant for the treatment of toe deformities were included. Thirty-one toes of 21 patients were evaluated retrospectively. American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were used in clinical evaluation.
Results
The mean operation duration per toe was 16.4 min (range, 13–26 min). The average AOFAS forefoot score was 42.76 (range, 23–57) preoperatively and 88.76 (range, 70–95) at 34.4 months (range, 26–46 months) after surgery. Mean follow-up was 14.8 months (range, 12–19 months). Compared with before surgery, the AOFAS score was increased significantly after surgery (P = .03 by t test). Three minor complications were encountered. In one patient an infection was observed. After the implants were removed (first month) she was treated successfully by debridement and antibiotic agents and, finally, Kirschner wire placement. The second patient had a fissure fracture at the proximal phalanx, but routine follow-up did not change. In the third patient, the locking mechanism had become loose (detected on day 1 radiography); it was remounted under fluoroscopy without opening the wound. No patients had a cutout, loss of alignment, recurrence, or persistent swelling.
Conclusions
Outcomes of arthrodesis using the two-component implant were found to be safe and reliable, especially for hammer toe and fifth toe deformities.
Background: Toe deformities are common foot abnormalities in older adults, contributing to functional disability, loss of balance, falls, and pressure lesions. The aim of this study was to evaluate the effectiveness of the custom-made molded silicone toe prop in distributing apical and metatarsophalangeal joint peak plantar pressures and force-time integral in toe deformities, including hammertoes and claw toes, and to observe any difference in pressures between flexible and rigid toe deformities.
Methods: A prospective quasi-experimental pretest/posttest study was conducted including 20 “healthy” older adults with a hammer or claw toe at the second digit. Ten subjects presented with a flexible toe and 10 subjects presented with a rigid toe. A molded silicone toe prop was devised for each participant. Dynamic plantar pressure measurements were taken/recorded before applying the toe prop and after the toe prop was placed under the toe.
Results: Significant differences in mean peak plantar pressure and pressure-time integral were observed at the apex of the second toe in both the flexible and rigid toe deformity when using a molded silicone toe prop. At the metatarsophalangeal joint, pressures were significantly reduced in the rigid toe deformity but not in the flexible toe deformity.
Conclusions: Silicone molded toe props were found to be effective in reducing peak pressure and pressure-time integral on the apex of the second digit in participants with both flexible and rigid claw or hammertoe deformity. Lesser toe deformities may be the cause of several foot complications, including pain on walking, corns, difficulty in wearing footwear, possible ulcerations caused by increased pressure at the apices of the toes, and other comorbidities, that could possibly lead to falls in older adults and thus need to be addressed appropriately.
Stress at the Second Metatarsal Bone After Correction of Hammertoe and Claw Toe Deformity
A Finite Element Analysis Using an Anatomical Model
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)
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, I 2 =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)
Abstract
Background: An abnormal hallux interphalangeal angle may be an important risk factor for the recurrence of ingrown toenails.
Methods: In this study, sixty pediatric patients who underwent surgery for an ingrown toenail were evaluated retrospectively in terms of recurrence. The patients were divided into two groups. Group 1 included 30 patients (22 male, 8 female) with hallux valgus interphalangeal deformity. Group 2 included 30 patients (20 male, 10 female) without toe deformity.
Results: The mean age was 12.8±1.42 years and 12.5±1.45 years for patients in Group 1 and in Group 2 respectively. There was no statistically significant difference between the patient and control group in terms of age and gender (p>0.05). The mean follow-up time was 40 months. We observed recurrence in six patients (20%) in Group 1 and in 2 patients (6.6%) in Group 2.
Conclusion: We concluded that the recurrence of an ingrown toenail may be associated with increased hallux interphalangeal angle in pediatric patients. Factors related to the hallux interphalangeal angle abnormality, which increases the risk of ingrown toenails, also increase the recurrence rate in these patients. Therefore, it is surmised that hallux valgus interphalangeal deformity should be evaluated before surgery, and patients and their families should be informed about the risk of increased recurrence.
The authors describe a procedure to syndactylize the fourth and fifth toes for the correction of failed fifth toe arthroplasty, flail fifth toe, overriding fifth toe, cocked-up fifth toe, heloma molle, and congenital digitus minimus varus. The procedure is technically simple and produces good cosmetic results.
We sought to evaluate the clinical and radiographic outcomes in patients treated with a medial displacement transverse osteotomy of the second metatarsal to correct transverse hammer toe deformities. Eighteen patients underwent 20 procedures in 3 years. Each patient had a transverse plane deformity of the second metatarsophalangeal joint. Evaluation consisted of clinical examination, radiographic examination, and self-reported pain and function parameters. Mean ± SD follow-up was 2.5 ± 1.0 years. Radiographic joint congruence improved from 20% before surgery to 95% after surgery. Clinical examination revealed a rectus digit in 85% of cases, a transverse plane deviation in 10%, and a residual hammer toe deformity in 5%. At follow-up, the mean ± SD visual analog scale score for pain with activity was 2.2 ± 2.8 and for pain at rest was 0.6 ± 1.4. Ninety-five percent of the patients said that they would undergo the procedure again. Medial displacement osteotomy for transverse plane deformity of the second metatarsophalangeal joint is a reliable procedure, with substantial improvement in joint congruence and self-reported pain. (J Am Podiatr Med Assoc 95(6): 550–555, 2005)
