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Review Question - QID 3277

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QID 3277 (Type "3277" in App Search)
A 57-year-old woman complains of pain and deformity of the second toe that is limiting ambulation. Shoe accomodations and NSAIDs have failed to provide relief. She has a fixed flexion deformity of 40 degrees at the PIP joint, but the MTP joint is not involved. The hallux is normal, but painless PIP flexion contractures are present in the other lesser toes. Which of the following is an indication for PIP resection arthroplasty as opposed to soft-tissue balancing and realignment?

Fixed deformity

84%

2774/3317

Pain with shoe wear

2%

50/3317

Presence of hammertoe deformity in all lesser toes

6%

206/3317

Absence of metatarsophalangeal joint deformity

6%

202/3317

Absence of a concomitant hallux valgus deformity

2%

72/3317

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Hammertoe is defined as a flexion deformity of the proximal interphalangeal joint. A diagram of the deformity is provided in illustration A. There are many causes including neurogenic, degenerative, and metabolic processes. Hammertoe can also be secondary to another deformity in the foot such as hallux valgus or curly toe. Consequently, there are numerous surgical procedures available for treatment including soft tissue releases, tendon transfers, resection arthroplasty, and arthrodesis. The presence of fixed deformity precludes success with soft tissue procedures alone.

O'Kane et al review 100 cases of excisional arthroplasty for second digit hammertoe. High rates of clinical satisfaction were achieved with only 2 revision surgeries. Floating toe was the most frequent complication (7). However, floating toe did not adversely affect shoe wear in any patient experiencing this complication.

Coughlin et al review 63 cases of excisional arthroplasty for fixed hammertoe. The resection arthroplasty was stabilized with K-wire fixation that led to bony fusion in 81% and fibrous union in the remaining 19%. Only minor complications occurred and 84% of patients reported high clinical satisfaction.

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