Claw toe deformity occurs most commonly in patients with diabetes, alcoholism, or an underlying neuromuscular condition. The classic presentation is a dorsiflexed MTP joint, and hyperflexion at the PIP and DIP joints. Surgical treatment is based on whether or not the PIP joint is flexible or fixed. The Girdlestone-Taylor procedure involves transferring the FDL to the extensor surface of the affected toe, allowing the long toe flexors to behave like intrinsic muscles producing active plantar flexion at the MP joints and extension at IP joints. This is only effective in the presence of a flexible deformity. PIP arthrodesis, MTP capsulotomy, and PIP joint resection arthroplasty are only indicated in varying degrees of a fixed claw toe deformity. A Weil osteotomy can be added in these fixed cases for added correction, or if multiple toes are involved. Illustration A shows a comparison of the different lesser-toe deformities.
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