Current Management of Lesser Toe Disorders, An Issue of Foot and Ankle Clinics

Overview

Mallet Toes, Hammertoes / Claw toes - PIP correction, Hammertoes / Clawtoes - MTP correction, Flexor-to-Extensor Transfer, Metatarsalgia: Distal Metatarsal Osteotomies, Metatarsalgia: Proximal Metatarsal Osteotomies, Crossover and Valgus Toe Deformity, Revision Lesser Toe Surgery, Freiberg's Infraction, Fifth Toe Deformities, Congenital Toe Deformities, Bunionette Deformity - Etiology & Exostectomy, Bunionette deformity - Osteotomies, Postoperative Complications

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Current Management of Lesser Toe Deformities, An Issue of Foot and Ankle Clinics

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Overview

Mallet Toes, Hammertoes / Claw toes - PIP correction, Hammertoes / Clawtoes - MTP correction, Flexor-to-Extensor Transfer, Metatarsalgia: Distal Metatarsal Osteotomies, Metatarsalgia: Proximal Metatarsal Osteotomies, Crossover and Valgus Toe Deformity, Revision Lesser Toe Surgery, Freiberg's Infraction, Fifth Toe Deformities, Congenital Toe Deformities, Bunionette Deformity - Etiology & Exostectomy, Bunionette deformity - Osteotomies, Postoperative Complications

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Product Details

  • ISBN-13: 9781455704491
  • Publisher: Elsevier Health Sciences
  • Publication date: 1/11/2012
  • Series: Clinics: Orthopedics Series
  • Pages: 538
  • Product dimensions: 6.20 (w) x 9.10 (h) x 0.60 (d)

Table of Contents

Preface: The Lesser Toes John T. Campbell xi

Mallet Toe Deformity Andrew Molloy Raheel Shariff 537

Mallet toe is flexion of the distal phalanx over the middle phalanx due to a contracture at the distal interphalangeal joint. Mallet toe apart from a sagittal plane deformity may also have medial or lateral deviation of the distal phalanx. Although lesser toe surgery is common, level I evidence and prospective studies are lacking to help determine which procedure is the most successful in achieving good clinical results. The authors offer a practical approach to the diagnosis and treatment of mallet toes for the practicing surgeon.

Hammertoes and Clawtoes: Proximal Interphalangeal Joint Correction J. Kent Ellington 547

Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists because of the underlying pathoanatomy. Hallux valgus, longer metatarsals, and intrinsic imbalance are the most common etiologies. Understanding the cause of the deformity is important to be able to successfully treat the condition, whether nonoperative or with surgical intervention. When nonoperative measures fail, proximal interphalangeal joint correction is best obtained through arthroplasty or arthrodesis.

Hammertoes/Clawtoes: Metatarsophalangeal Joint Correction Carolyn Chadwick Terry S. Saxby 559

Clawing of the lesser toes is not uncommon, can arise from a number of causes, and is often associated with other forefoot abnormalities. This article discusses the etiology, pathophysiology, and clinical examination of hammertoes and clawtoes. Conservative (nonoperative) treatments are described, followed by a consideration of surgical options of correction at the metatarsophalangeal joint, which consist of soft-tissue, bony, and joint ablation procedures.

The Use of Flexor to Extensor Transfers for the Correction of the Flexible Hammer Toe Deformity John Y. Kwon Richard J. De Asla 573

Hammer toe is flexion deformity of the proximal interphalangeal joint and is often associated with ill-fitting shoe wear. Less commonly it can be attributed to congenital and neuromuscular conditions. Multiple factors contribute to development, but prevalence is higher in women and with advanced age. Hammer toe is characterized by a proximal interphalangeal flexion deformity without significant abnormality at the distal interphalangeal joint. Flexor to extensor transfer is useful to correct a flexible hammer toe deformity. Although satisfaction rates have varied in the literature, this technique remains a useful tool to improve toe deformity, decrease pain, and aid in shoe wear.

Metatarsalgia: Distal Metatarsal Osteotomies Reinhard Schuh Hans Joerg Trnka 583

Metatarsalgia refers to pain near the metatarsal heads or metatarsophalangeal joints. The causes of metatarsalgia can be categorized in 3 groups. Nonoperative treatment includes shoe wear modification, customized insoles with a metatarsal bar, and gastrosoleus stretching exercises. If conservative treatment fails, operative reconstructive procedures should be considered. The main purpose of osteotomies is to decrease the prominence of the offending metatarsal head by dorsiflexing the metatarsal head, shortening the metatarsal head, or some combination thereof.

Metatarsalgia: Proximal Metatarsal Osteotomies Christopher J. Pearce James D. Calder 597

Metatarsalgia is a common complaint that is frequently seen in patients attending a foot and ankle clinic. The mainstay of treatment in metatarsalgia is nonoperative, there is little written about the effectiveness of nonoperative treatments. Surgical treatment of metatarsalgia is indicated when conservative measures have failed to improve the patient's symptoms. This article describes proximal lesser metatarsal osteotomies and includes the authors' preferred approach, as well as possible complications.

The Crossover Toe and Valgus Toe Deformity James Sferra Steven Arndt 609

Second toe problems are among the most common of all forefoot complaints. Its proximity to the hallux combined with limited motion at the second tarsometatarsal joint likely contributes to the second metatarsophalangeal joint being the most common to experience both pain and deformity. Many causes have been linked to this problem, which has led to many surgical techniques to correct this deformity. Although many techniques have been described, a systematic approach relying first on soft tissue releases and plication followed by osteotomies as necessary has led to satisfactory outcomes in the treatment of this difficult problem.

Revision Surgery of the Lesser Toes Matthew C. Solan Mark S. Davies 621

Foot pathology can be extremely debilitating and the lesser toes are no exception. There are a plethora of operative procedures that can transform the lives of patients suffering from lesser toe disorders. Many lesser toe problems are poorly assessed and many inappropriate operative procedures are performed. This causes further misery for the patients concerned.

Freiberg's Disease Rebecca A. Cerrato 647

Freiberg's disease is a relatively uncommon disorder of the metatarsal head. Although trauma or circulatory disturbances likely have a major role in its development, it is widely accepted that Freiberg's disease is multifactorial. Conservative treatment focused on offloading and relieving stress is uniformly accepted as the appropriate initial management. Surgical management attempts to correct the pathophysiology and halt its progression and address the sequelae of later stage disease. Newer strategies including osteochondral transplantation attempt to restore the damaged metatarsal cartilage with a viable osteochondral plug.

Congenital Lesser Toe Abnormalities Ho-Seong Lee Woo-Chun Lee 659

The treatment of congenital abnormalities of the lesser toes should be individualized to the pathology present. Goals of treatment include pain relief, proper alignment of the toes, and comfort with wearing shoes. Meticulous surgical technique can minimize complications and optimize clinical outcomes for these patients.

Bunionette Deformity: Etiology, Nonsurgical Management, and Lateral Exostectomy Todd Bertrand Selene G. Parekh 679

Bunionette is a term used to characterize a lateral prominence of the fifth metatarsal head. This article discusses the etiology, clinical presentation, and radiographic imaging of bunionettes. Though they very rarely become significant enough to warrant treatment, nonsurgical and surgical management of bunionettes is described for cases in which it is required and ample illustrative material is provided.

Osteotomies for Bunionette Deformity Lowell Weil Jr Lowell Scott Weil Sr 689

A tailor's bunion or bunionette deformity is a combination of an osseous and soft-tissue bursitis located on the lateral aspect of the fifth metatarsal head. This article describes surgical management of tailor's bunion, including guidelines at the Weil Foot & Ankle Institute. Various surgical osteotomy procedures are described: medial oblique sliding osteotomy; medial, oblique slide osteotomy; SERI (Giannini-Simple, Effective, Rapid, Inexpensive); chevron; Weil osteotomy; closing, lateral wedge osteotomy at metatarsal neck or proximal diaphysis; oblique diaphyseal osteotomy; and Scarfette.

Index 713

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