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Sep 07, 2006
Hammer toe surgery
by SirGan
Hammer toe is one specific condition caused by an inherited muscle imbalance or abnormal bone length. Researches show that it mostly occur in children who outgrow their shoes rapidly because - in this condition one or more small toes buckle when the middle joint contracts. This causes the tendons to shorten. It is also important to know that a foot with a bunion will often have a hammer toe also. Problem is that, over time, this bunion slants the big toe toward and then under the second toe which forces the second toe to rise into a claw-like position. Patient should know that a hammer toe can lead to severe pain and pressure because it creates extra stress in the ball of the foot, often leading to the development of corns and calluses. However- good thing is that there is several treatment options for the correction of hammer toe deformity. If the deformity is not treated, the toe may become permanently fixed and rigid.
What are Deformities of the Toes?It is important to point out that this hammer toe problem is one of the commonest deformities of the toe! Everyone should know that the human foot is a highly complicate mechanical apparatus. It is made of many bones and other coordinated structures. Most common deformities of the toes are
People should know that, although they are somewhat similar in appearance, each deformity has specific characteristics. Variations in the three conditions are caused by differences in the direction the joints of the affected toes bend, as well as in degrees of deformity.
These deformities often cause pain and a loss of function in the use of the foot. Although many people consider these deformities to be something not so serious- it is proven that failure to treat these conditions may contribute to the development of serious and disabling changes in habitual ways of walking and carrying the body.
Possible causes of hammer toeEvery patient should know that the main cause of hammer toe is simple wearing tight shoes that crowd the toes, or high heels. Of course- this isn't only possible case because it is proven that it may also be brought on by an injury. When we talk about possible mechanism of the disorder- then we should know that the cause of the condition is a tightening of the ligaments and tendons of the toe, causing a buckling of the joint of the toe. So, what happens as a result? It is cocking of the toe upward, whereas in a normal foot, the toes lie flat. If the deformity is not treated, the toe may become permanently fixed and rigid.
A hammer toe may also develop because of:
Symptoms of hammer toeBesides pain and its claw-like physical appearance, symptoms of hammer toe include:
Surgical treatment of hammer toeAlthough, different experts are describing different treatment procedures have -surgery for the correction of hammer toe deformity is most common method and it is approached via a sequential protocol which means that if one procedure does not work, another is tried until the deformity is reduced.
Pre-operative PreparationsBefore surgery, the patient usually receives appropriate anesthesia, and the foot is well cleansed and draped. Certain experts have favored the injection of 5% marcaine locally at the base of the toe.
Surgical IncisionEvery patient should know a bit about the procedure and the fact that the first step in the surgical correction of a hammer toe should be the initial incision. There are several possible. The most frequently sited method involves a dorsal longitudinal incision extending from the MTPJ distally to the mid-point of the intermediate phalanx. It is also very important to point out that the second most commonly sited incision approach is one also known as ‘two semi-elliptical. Patient should know that the length of the incision must be approximately three times the width so as to ensure adequate closure of the wound post-surgery. The linear incision is carried deep into the superficial fascia with care taken to maintain haemostasis. The deep fascia is identified and the tissues reflected medially and laterally to expose the internal structures.
Extensor Tendon LengtheningThis is usually the first correction which is made to the tendon of extensor digitorum longus muscle which is lengthened in an open Z-plasty, and retracted with the tip of a curved hemostat. This is causing the curvature! What's the next step? Well, next the collateral ligaments are severed with the scalpel aligned parallel to the long axis of the proximal phalanx- which should relieve all the problems with contracture!
Proximal Interphalangeal Joint ArthroplastySome experts are practicing another method which involves the distal aspect of the proximal phalanx which is being excised at or just proximal to the neck of the phalanx. They explain that the medial and lateral margins are then smoothed using a rongeur and a fine rasp, and the articular surface of the intermediate phalanx is removed. Important thing to do is to test whether adequate correction has been obtained, so the push up test is repeated. Only in case that the test show that the MTPJ does not realign, correction has not been fully achieved so either more bone is resected from the proximal phalanx or an extensor hood release is performed.
Extensor Hood ResectionIt is also important to know some facts about this procedure! The fact is that, if the extensor tendon has been lengthened without the release of the extensor hood, there is one problem which will definitely occur- looseness will only be experienced distal to the MTPJ. However, when the extensor hood is released, the tendon lengthening will create ‘slack’ throughout the length of the tendon and across the MTPJ. Extensor hood resection is performed by first placing the tendon on stretch distally and excising the hood fibers medially and laterally at their attachments to the joint capsule and extensor sling.
Metatarsophalangeal Joint CapsulotomyBefore one procedure called metatarsophalangeal joint capsulotomy, the extensor digitorum longus muscle and the soft tissue medial and lateral to the MTPJ are being retracted. This part is extremely important because it identifies the site for capsulotomy.
Proximal Interphalangeal Joint ArthrodesisAfter all these procedures – there is one which is made in order to prevent recurrence of the deformity and ensure the success of the procedures.
Living with Hammer ToeEveryone should know that any change to one part of the foot significantly affects habitual ways of walking and standing. Of course- then it is reasonable to assume that if this condition is being left untreated, foot ailments such as claw toe, hammer toe, or mallet toe may produce problems in other weight-bearing joints. That’s why- any forefoot problems causing pain or discomfort should be given prompt attention. Therefore all people who experience problems with their feet should seek advice from an experienced physician or podiatrist.
Possible complications1. Swelling of the toes for 1 to 6 months post surgery.
2. Recurrence of deformity. 3. Distraction of the K-wire pin from the digit. 4. Infection 5. Pain and discomfort after the operation 6. Injury to the neurovascular bundle |
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