Treatment of Flexible Lesser Toe Deformities

Frey-Ollivier, Solenne; Catena, Fernanda; Hélix-Giordanino, M; Piclet-Legré, Barbara

doi:10.1016/j.fcl.2017.10.002

Cited by 31 publications

(16 citation statements)

References 19 publications

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“…In this way, the interphalangeal joints could reestablish their physiological functionality. IOs are techniques especially indicated for reducible or semi-rigid deformities of the fingers [17].…”

Section: Introductionmentioning

confidence: 99%

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The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

et al. 2019

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Background Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. Methods A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. Results The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = − 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). Conclusion The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. Trial registration The study was based on retrospectively registered data starting on May 24, 2008.

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Section: Introductionmentioning

confidence: 99%

“…The surgical technique of IO has been well described in the literature [16, 17]. However, the clinical outcome and the rate of complications of IO applied to LTD have never been addressed.…”

Section: Introductionmentioning

confidence: 99%

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

et al. 2019

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“…25,31,34 Most of these implants have not demonstrated improved complication and revision rates when compared to K-wire fixation. 14,19,21,33,34,44,45 A novel class of biointegrative fixation implants has been developed to provide strong, secure fixation while gradually integrating into native tissue. These implants are engineered from continuous reinforcing mineral fibers bound together by a bioabsorbable polymer [poly(L-lactide-co-D,L-lactide), PLDLA] matrix.…”

Section: Introductionmentioning

confidence: 99%

“…25,31,34 Most of these implants have not demonstrated improved complication and revision rates when compared to K-wire fixation. 14,19,21,33,34,44,45…”

Section: Introductionmentioning

confidence: 99%

Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

Cicchinelli¹,

Štalc

Richter³

et al. 2020

Foot & Ankle Orthopaedics

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Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.

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“…It was originally designed to treat flexible claw toes. 6 Now, this process is often combined with plantar plate repair, proximal interphalangeal arthrodesis, or Weil osteotomy to treat more complicated lesser toe deformities. [2][3][4]7,9 In addition to flexible claw toes, the indications of the procedure include the hammer toe, the crossover toe, and the metatarsophalangeal (MTP) joint instability, even some of the lesser toe deformities in rheumatoid conditions, stroke, and spinal cord injury.…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study

Wei

Yao

Amendola

2019

Foot & Ankle Orthopaedics

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Background: The transfer of flexor-to-extensor is widely used to correct lesser toe deformity and joint instability. The flexor digitorum longus tendon (FDLT) is percutaneously transected at the distal end and then routed dorsally to the proximal phalanx. The transected tendon must have enough mobility and length for the transfer. The purpose of this study was to dissect the distal end of FDLT and identify the optimal technique to percutaneously release FDLT. Methods: Eight fresh adult forefoot specimens were dissected to describe the relationship between the tendon and the neurovascular bundle and measure the width and length of the distal end of FDLT. Another 7 specimens were used to create the percutaneous release model and test the strength required to pull out FDLT proximally. The tendons were randomly released at the base of the distal phalanx (BDP), the space of the distal interphalangeal joint (SDIP), and the neck of the middle phalanx (NMP). Results: At the distal interphalangeal (DIP) joint, the neurovascular bundle begins to migrate toward the center of the toe and branches off toward the center of the toe belly. The distal end of FDLT can be divided into 3 parts: the distal phalanx part (DPP), the capsule part (CP), and the middle phalanx part (MPP). There was a significant difference in width and length among the 3 parts. The strength required to pull out FDLT proximally was about 168, 96, and 20 N, respectively, for BDP, SDIP, and NMP. Conclusion: The distal end of FDLT can be anatomically described at 3 locations: DPP, CP, and MPP. The tight vinculum brevis and the distal capsule are strong enough to resist proximal retraction. Percutaneous release at NMP can be performed safely and effectively. Clinical Relevance: Percutaneous release at NMP can be performed safely and effectively during flexor-to-extensor transfer.

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Treatment of Flexible Lesser Toe Deformities

Cited by 31 publications

References 19 publications

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study

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