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Introduction
  • A congenital deformity characterized by a digit that overlaps another 
  • Epidemiology
    • demographics
      • evenly distributed between males and females
    • body location
      • the fifth toe most commonly affected
      • usually bilateral
  • Pathophysiology
    • pathoanatomy
      • due to contraction of the extensor digitorum longus
  • Genetics
    • often familial
Presentation
  • Symptoms
    • may cause problems with shoe wear
  • Physical Exam
    • adduction and slight external rotation of the affected digit
    • metatarsophalangeal joint is dorsiflexed 
    • the nail plate is smaller than the contralateral digit
Treatment
  • Nonoperative
    • passive stretching and buddy taping
      • indications
        • first line of treatment
  • Operative
    • surgical correction
      • indications
        • fails nonoperative treatment and remains symptomatic
      • technique
        • Butler procedure    
          • perform racket handle incision then release the extensor digitorum longus
        • tenotomy vs. dorsal capsulotomy vs. syndactylization with fourth toe (McFarland procedure)
 

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