Gregory J. Kramer, DPM, FACFASAnkle and Foot Associates

of Southern Georgia

HAMMERTOESCAUSES AND CORRECTIONS

AnatomyClassificationEtiologyTreatment

SurgicalArthroplasty vs. Arthrodesis

OrthoPro Screw

HammertoesAbnormal contracture of the joints of the lesser digits

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Osseous StructuresSoft Tissue Structures

ANATOMY

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MetatarsalHead Shaft Base

PhalangesProximalMiddleDistal

Head Shaft Base

ArticulationsMetatarsal Phalangeal Joint (MPJ)Proximal Interphalangeal Joint (PIPJ)Distal Interphalangeal Joint (DIPJ)

Osseous Structures

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Tendons

ExtrinsicExtensor digitorum longusFlexor digitorum longus

IntrinsicExtensor digitorum brevisFlexor digitorum brevisDorsal and Plantar InterosseiLumbriclesQuadratus plantae

Soft Tissue Structures

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Classic HammertoeClaw ToeMallet ToeRigidFlexible

Classifications

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Classic Hammertoe

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Claw Toe

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Mallet Toe

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Push Up Test

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GeneticAcquired

Shoe gearTraumaBiomechanical

Flexor StabilizationFlexor SubstitutionExtensor Substitution

Etiology of Hammertoes

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ConservativeSurgical

Treatment

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Shoe modificationAccommodative paddingOrthotic devices

Conservative

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Surgical Treatment

“You have this” “We are going to give you this”

“Is it really that simple?”

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Soft Tissue ProceduresOsseous ProceduresSequential Release

Surgical Treatments

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• Tenotomy• Extensor tenotomy and capsulotomy• Flexor tenotomy and capsulotomy• Flexor tendon transfer

Soft Tissue Procedures

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Resection of base of proximal phalanx

SyndactylizationArthroplastyArthrodesis

Osseous Procedures

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Sequential Release

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Most common procedure performed for hammertoe correction

May or may not require fixationUsually requires addition of soft tissue

procedures

Arthroplasty

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Types of fixation K-wireAbsorbable rodImplantsShaw rodShip implant

Arthroplasty

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Usually requires addition of soft tissue procedures

Is not performed on the fifth digitRequires fixationTypes of fixation

K-wires (smooth or threaded)ScrewsVarious implants

Arthrodesis

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End to EndPeg in holeInsitu

Types of Arthrodesis

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Arthroplasty

Most common procedure performed for hammertoe correction

Technically easy procedure Some motion is retained Shortening of digit is inherent to

procedure May be unstable Increased chance of recurrence of

hammertoe deformity Fixation

K-wire Implant

Indications Flexible to semi – rigid deformity

Not as common Technically more difficult procedure No motion, toe is rigid Maintains relative length of digit Stable Minimal chance of recurrence Longevity of correction Fixation

Screw Threaded or Smooth K-wire Implant

Indications: Loss of Intrinsic muscle stability

Diabetes Neuromuscular conditions

ARTHROPLASTY VS. ARTHRODESIS

Athrodesis

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Technically easy No exposed K-wire

Less chance of pin tract infection No need to remove the pin at a later date Less chance of bending or breaking of the pin Quicker return to bathing and shoe gear

Provides superior compression Provides stability even in the face of pseudoarthrosis Stabilizes both distal and proximal interphalangeal joints

ADVANTAGE OF ORTHOPRO SCREWS OVER K-WIRES OR IMPLANTS FOR USE IN DIGITAL ARTHRODESIS

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Don’t try to be an expert on procedure choiceBe the expert on your implantKnow the technical aspects of your implant

(i.e. lengths, diameter, etc.)

Quips and Tips

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