The ankle and foot
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The commonest deformities of the lesser toes are ‘claw’, ‘hammer’ and ‘mallet’ (Figure 21.28). These terms are often used interchangeably, leading to confusion. Claw toe is characterized by hyperextension at the MTP joint and flexion at both IP joints.Hammer toe is an acute flexion deformity of the proximal IP joint only; in severe examples there may be some extension at the MTP joint. The distal IP joint is either straight or hyperextended.Mallet toe is a flexion deformity of the distal IP joint.
Surgery of the Foot
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
The decision-making process for correction of lesser toe deformities must take into account the type of deformity and whether it is fixed or flexible. A detailed examination of the deformity must be made in the awake patient prior to surgery. The position of the toe in the standing and lying position must be noted and any deformity assessed for a fixed component. Any subluxation or dislocation of the MTPJ must be identified. There is some confusion in the literature regarding toe deformity nomenclature. For the purposes of this book we have used the following terms: Mallet toe: A flexion deformity of the distal IPJ (DIPJ), often resulting in a callosity on the tip of the toe.Hammer toe: A flexion deformity of the proximal IPJ (PIPJ), often associated with hyperextension of the DIPJ and an accommodative hyperextension of the MTPJ.Claw toe: A term usually reserved for multiple toes and often associated with an underlying neurological condition. The primary deformity is one of hyperextension of the MTPJ with secondary flexion of the PIPJ.
Foot and ankle disorders
Maneesh Bhatia, Tim Jennings in An Orthopaedics Guide for Today's GP, 2017
Mallet toe is due to a flexion deformity of the distal interphalangeal (DIP) joint. It usually involves the longest lesser toe. It could be due to a congenital or developmental anomaly. The most common cause of an adult onset mallet toe is the lack of sufficient space for the longest toe in the shoe (Figure 8.21).
Triple osteotomy for erosive first metatarsal in a patient with rheumatoid arthritis: a case report
Published in Modern Rheumatology Case Reports, 2021
Haruki Tobimatsu, Katsunori Ikari, Koichiro Yano, Ken Okazaki
Rheumatoid arthritis (RA) commonly affects the metatarsophalangeal (MTP) joints. Chronic synovitis in the MTP joints subsequently results in various forefoot deformities, including hallux valgus, dislocation of the lesser toes and hammer toe deformity. Although a variety of operative procedures have been performed for forefoot deformities in patients with RA, arthrodesis of the first MTP joint and resection arthroplasty of the lessor toes has been performed most widely. However, these procedures sacrifice the function of the MTP joints. Recently, the clinically beneficial effects of disease modifying anti-rheumatic drugs (DMARDs), including biological DMARDs, have dramatically controlled RA disease activity. Over the half of the patients achieved clinical remission, while only 1.5% of the patients classified as high disease activity by the disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) in a Japanese RA cohort [1]. Since joint damage presumably does not progress in patients in clinical remission, there is a consequent trend towards joint-preserving arthroplasty for forefoot deformities in patients with RA. Here we report a double first metatarsal osteotomy to preserve the articular surface of the first MTP joint for a patient who had lost half of the metatarsal distal articular surface because of bony erosion.
Advances in pharmacotherapy for diabetic foot osteomyelitis
Published in Expert Opinion on Pharmacotherapy, 2021
Raju Ahluwalia, Jose Luiz Lázaro-Martínez, Ines Reichert, Nicola Maffulli
The diagnosis of infection is usually clinical (Table 1). Microbiological characterization is essential, as it allows identification of the bacteria involved and to plan appropriate antibiotic treatment. A DFO is the consequence of the soft tissue infection arising from a DFU spreading into bone, involving the cortex first and then the bone marrow. The identification of necrotic bone, which can be a stigma of infection, is an important prognostic marker, and healing requires viable bone, and thus resection of all dubious material to fresh bleeding tissue or clear margins [6,18]. Septic arthritis is seen acutely and is beyond the scope of this article. However, chronic issues that result from it, such as hammer toe ulceration are. Recurrence of a DFU or the inability to achieve healing is suggestive of a chronic DFO, and chronicity is defined by not healing within the expected time [6].
Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery
Published in Modern Rheumatology, 2021
Koji Ohta, Jun-ichi Fukushi, Satoshi Ikemura, Satoshi Kamura, Hisa-aki Miyahara, Yasuharu Nakashima
In the present study, there was no significant difference in the alignment score on the JSSF lesser toe scale between the two groups (0.5 in the Healed, and 1.8 in the Delayed groups). An alignment score of 15 indicates good alignment, a score of 8 indicates mild-to-moderate malalignment that is easily correctable, and a score of 0 indicates severe malalignment that is uncorrectable [9]. However, a floor effect should be taken into account, because the majority of the patients had uncorrectable hammer toe. Therefore, we sought to quantitatively evaluate the uncorrectable deformity by measuring the height of 2nd PIP, which was not associated with a delay in wound healing. However, a previous study reported an association between delayed wound healing and preoperative dorsoplantar deformity of the lesser toes following rheumatoid forefoot surgery [4]. Whether the degree of hammer toe deformity affects wound healing should be determined in future studies, using a reliable, quantitative method of evaluation. Although not significant, the function score on the Lesser toe scale showed a tendency to be lower in the Delayed group than the Healed group (13.7 ± 7.9 and 18.0 ± 9.3, respectively, p = .085). Thus, given that the Lesser toe total score was significantly lower in the Delayed group, we believe that the total severity of rheumatoid forefoot disorder is associated with delayed wound healing.
Related Knowledge Centers
- Interphalangeal Joints of The Foot
- Toe
- Metatarsophalangeal Joints
- Morton'S Toe
- Arthritis
- Diabetes
- Shoe
- Bunion
- Osteoarthritis
- Rheumatoid Arthritis