Hammer toe syndrome. American College of Foot and Ankle Surgeons.
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Foot Deformities↗
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Results for “Hammer Toe Syndrome”
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Ectopic dermal ridge configurations on the interdigital webbings of Hammertoe mutant mice (Hm): another possible role of programmed cell death in limb development.
BACKGROUND: The mechanism underlying the development of aberrant phalangeal pads and dermal ridge configurations in malformed limbs is not well understood. The forelimbs of Hammertoe (Hm) mutant mouse fetuses were examined sequentially to clarify the relationship between the occurrence of abnormal programmed cell death (PCD) and the formation of phalangeal pads and dermal ridge patterns. METHODS: Relevant morphological features, with special emphasis on pads and dermal ridge configurations, were inspected on the exposed dermal surface of the forelimbs of adult Hm mutant mice. The forelimbs of Hm mutant mouse fetuses (GD13-18) and newborns were examined histologically. The forelimbs of GD13 fetuses were subjected to Nile blue (NB) vital staining for in situ labeling of PCD. RESULTS: In the forelimbs of +/+ mice, the formation of dermal ridges was confined to pads, while in Hm/+ and Hm/Hm animals, which have interdigital webbing involving digits II-V, dermal ridges were formed also on the ventral side of the webbing, specifically on its lateral margins between the neighboring digits and on the medial margin of the webbing extending toward the palmar pad. PCD was decreased in the interdigital zones II-IV in GD13 Hm/+ and Hm/Hm fetuses. CONCLUSIONS: Reduced PCD interdigital tissue of Hm/+ and Hm/Hm fetuses may result in the failure of physiological elimination of interdigital cells and in the persistence of soft tissue webbing between digits. The failure of PCD to occur may also interrupt the interdigital surviving cells to reach the neighboring digits and the distal area of the palm, thereby producing ectopic dermal ridges. It seems that interdigital PCD contributes not only to digit separation but also to the development of digital and palmar pads.
Animals↗
Plantar pressure distribution analysis in normal weight young women and men with normal and claw feet: a cross-sectional study.
We analyzed the plantar support in 72 normal-weight young voluntaries (46 women, 26 men), by a baropodometric platform. We considered subjects with claw foot (CFS) and subjects with normal foot (NFS). We found a significant reduction of total plantar support surface in the CFS (P < 0.0001 for women, P < 0.001 for men), due to the reduction of the forefoot and rear foot areas of both plantar imprints. Indeed, CFS of both sexes exhibited higher values of both plantar pressure and peak pressure, compared to the NFS. Moreover, the load per units of plantar surface increased in CFS compared to the NFS. In conclusion, the reduction of plantar support surfaces in CFS of both sexes was associated to a major load per units of plantar surface in the forefoot and rear foot areas, and this may be a risk factor to lower extremity overuse injuries.
Adolescent↗
[Talipes cavus and pes cavus with marked hammer toes].
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Clubfoot↗
[Lesser toe deformities. Definition, pathogenesis, and options for surgical correction].
Whereas in the past resection arthroplasty was - in analogy to hallux valgus surgery - the preferred therapy to correct lesser toe deformities, the point of view has undergone a change. Much interest is directed toward functional aspects that require reconstructive management. Whenever possible the integrity of joint play should be saved. Above all the metatarsophalangeal joint of the lesser toes is worth being preserved to prevent a severe disturbance of the biomechanics of the foot. Tendon transfers and subtle corrective osteotomies such as the Weil procedure allow restricting resection procedures to contraction deformities.
Arthroplasty↗
[Inserts for foot deformities].
Inserts are orthopedic aids in the treatment of foot disorders that result from changes of the static or dynamic situation. Provision of appropriate orthopedic devices can relieve the pain caused by forefoot deformities either in lieu of surgical intervention or in rare cases also following surgical treatment to improve the symptoms of residual pain.Available materials provide support, padding, and cushioning. Inserts are custom-made to measure and/or based on a plaster impression. Determining the indication, prescribing the inlay, and checking the orthosis are the tasks of the physician. One treatment option for relieving the pain of forefoot deformities consists in conservative therapy with an insert combining features of padding and support as well as adjusting a ready-made shoe. The shoe and inlay should constitute a functional unit since often the optimal effect is only achieved with a combination of insert and orthopedic adjustment of the ready-made shoe.
Foot Deformities↗
Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis.
Hyperextension of the metatarsophalangeal joint is the key component of claw toe deformity. We describe an arthroscopic technique to stabilize the plantar plate and reduce the metatarsophalangeal joint. Under arthroscopic guide, the dorsal capsule is released. The plantar plate is anchored and sutured to the extensor digiturum longus tendon. In case of overriding toe deformity, the medial capsule is also reduced and lateral capsule is plicated under arthroscopic guide.
Arthroscopy↗
Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity.
Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer toe deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer toe deformity, and 13 age- and gender-matched neuropathic diabetic controls without deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force-time integral for each of 11 foot regions were calculated. Degree of toe deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with toe deformity (mean 626 (SD 260)kPa) when compared with controls (mean 363 (SD 115) kPa, P<0.005). MTH peak pressure was significantly correlated with degree of toe deformity (r=-0.74) and with fat-pad displacement (r=-0.71) (P<0.001). The ratio of force-time integral in the toes and the MTHs (toe-loading index) was significantly lower in the group with deformity. These results show that claw/hammer toe deformity is associated with a distal-to-proximal transfer of load in the forefoot and elevated plantar pressures at the MTHs in neuropathic diabetic patients. Distal displacement of the plantar fat pad is suggested to be the underlying mechanism in this association. These conditions increase the risk for plantar ulceration in these patients.
Diabetic Foot↗
Falls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms.
OBJECTIVE: Documented falls after lower-extremity-nerve blocks are rare. We believe this paucity of documented falls is the result of underreporting and the lack of serious complications resulting from these falls. In addition, the mechanism(s) for falls after lower-extremity-nerve blocks has not been elucidated. CASE REPORTS: These reports highlight the mechanism of fall in a patient with a femoral-nerve block (FNB) and in a patient with a femoral-nerve and sciatic-nerve block (FNB/SNB). In addition, we report our findings when volunteers underwent FNB, sciatic-nerve block (SNB) and FNB/SNB and were studied in a gait-analysis laboratory. CONCLUSIONS: Lower-extremity-nerve blocks result in decreased leg stiffness and lateral instability, which may lead to difficulty with pivoting maneuvers.
Accidental Falls↗
Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy.
Various foot structures are thought to influence forefoot plantar pressures during walking. High peak plantar pressures (PPP) during walking in people with diabetes mellitus (DM) and peripheral neuropathy (PN) can cause skin breakdown. The question addressed by this study is "What are the primary forefoot structural factors that predict regional PPP during walking in groups of people with and without DM and PN?" Twenty people with DM and PN (mean age 55+/-9 years, 6 female, 14 male, BMI=33+/-8) and 20 people without DM, matched for gender, age, and BMI were tested. Measures of foot structure were taken from three-dimensional images constructed from spiral X-ray computed tomography. Peak plantar pressure data were recorded during walking. Hierarchical multiple regression analysis was used to predict regional PPP at the great toe and five metatarsal heads from selected structural and walking variables. Metatarsal phalangeal joint angle (hammer toe deformity) was the most important variable predicting pressure, accounting for 19-45% of the PPP variance at five of the six locations in the DM group. Soft tissue thickness, hallux valgus, and forefoot arthropathy were the most important predictors of PPP in the control group. Combinations of structural and walking variables accounted for 47-71% of the variance in the DM group and 52-83% of the variance of PPP during walking in the control group. These structural variables, especially hammer toe deformity, should be considered in attempts to develop strategies to reduce excessive forefoot PPP that may contribute to skin breakdown or other injury.
Diabetes Mellitus↗
[Post stroke hemiplegia: lower limb benefit from botulinum toxin (review)].
OBJECTIVE: To clarify the conditions governing the use of botulinum toxin (BTX) for post-stroke lower limb spastic disorders: indications, choice of muscles, doses, and duration of efficacy. METHOD: Review of the international literature using the Medline and the Reedoc data banks. RESULTS: Seven controlled studies were reviewed, including in particular 2 studies vs placebo and one vs phenol, 7 open studies or case series closely related to this topic and 4 open studies partly dedicated to it. The usefulness of BTX for the treatment of equinovarus has been demonstrated. The main muscles to be treated are the soleus, gastrocnemius and tibialis posterior. The treatment proposed for toe clawing is BTX injection into the flexor digitorum longus and flexor hallucis longus, and for great toe permanent extension, injection of the extensor hallucis longus. The quadriceps femoris, the tibialis anterior or the hamstrings have only be treated in isolated cases. When the treatment is effective, its benefit may last for more than 6 months. DISCUSSION: A few controlled trials have demonstrated the efficacy of BTX for post stroke lower limb spasticity. The results of all the controlled and open trials argue in favor of its efficacy, but this still requires more thorough analysis. CONCLUSION: Botulinum toxin has a place together with other local treatments for post-stroke spasticity, but a precise guide to its use, especially its dosage, and it's effectiveness compared to that of other treatments, need further study.
Anti-Dyskinesia Agents↗
Foot deformities: biomechanical and pathomechanical changes associated with aging, Part I.
This article reviews the most common foot deformities and pedal pathomechanical conditions that often result in pain and disability in the elderly. A description of the deformity or condition, its etiology, presenting symptoms, and various nonsurgical approaches to treatment are explored. The primary goal in all cases is to maintain or improve the patient's ability for comfortable, independent ambulation.
Aged↗
Second metatarsophalangeal joint fusion: a new technique for crossover hammertoe deformity. A preliminary report.
The author reports on second metatarsophalangeal joint arthrodesis for the severe crossover hammertoe deformity. Eleven patients underwent an arthrodesis of the second metatarsophalangeal joint with a.062 Kirschner wire intramedullary fixation and a dorsal small bone staple and resection of the proximal phalangeal head of the second digit. Outcomes were retrospectively reviewed at average follow-up time of 19 months. A subjective patient satisfaction survey along with a clinical and radiographic evaluation was undertaken in the postoperative period. Ten of 11 patients scored good to excellent results based on the patient subjective survey at final follow-up. Ten of 11 patients obtained primary arthrodesis. One patient experienced an asymptomatic nonunion. This new technique appears to be reliable for the maintenance of long-term correction of a crossover second toe with arthrodesis of the second metatarsophalangeal joint.
Adolescent↗
[Lesser toe deformities].
Lesser toe deformities often lead to painful calluses and metatarsalgia. Depending on the different underlying etiologies it is mandatory to perform a meticulous clinical assessment including the whole foot and the entire lower limb. Prior to any surgical interventions it is necessary to evaluate the deformity at all three joint levels. The metatarsophalangeal joint acts as a key joint. Any dorsal subluxation or dislocation has to be addressed first. This may include various soft tissue procedures and shortening osteotomies of the metatarsals. After successful realignment contractures of the distal joints have to be corrected. Since function of the lesser toes mainly depends on stability of the distal joints arthrodeses of the proximal and distal interphalangeal joints are superior to any resection arthroplasties.
Arthrodesis↗
Modified Girdlestones-Taylor procedure for claw toes in spinal cord injury.
STUDY DESIGN: A combination of review of case notes and outpatient follow-up. OBJECTIVE: To evaluate the effectiveness of the modified Girdlestones-Taylor procedure in patients with spinal cord injury (SCI). SETTING: Princess Royal Spinal Injuries Centre (PRSIC), Northern General Hospital, Sheffield, UK. METHODS: Nine patients with claw toe deformities to 27 toes were treated at the PRSIC from 1996 to 2005. After examination of their medical records, their toes were assessed for pain, residual deformity and stiffness. They were also asked to grade their satisfaction with the surgical outcome. The results were tabulated. RESULTS: The average age of our series of patients was 43.3 years. The mean time from injury to surgery was 20.4 years and the mean time from surgery to last follow-up was 37.3 months. All our patients had good to excellent results, with over 70% of the toes having excellent results. CONCLUSION: The modified Girdlestones-Taylor procedure for claw toe correction appears to be a safe and effective treatment for patients with SCI.
Adult↗
Lesser digital fusion with a cannulated screw.
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Arthrodesis↗
A bioabsorbable fixation implant for use in proximal interphalangeal joint (hammer toe) arthrodesis: Biomechanical testing in a synthetic bone substrate.
The surgical correction of hammer toe deformity of the lesser toes is one of the most commonly performed forefoot procedures. In general, percutaneous Kirschner wires are used to provide fixation to the resected proximal interphalangeal joint. Although these wires are effective, issues such as pin tract infections as well as difficult postoperative management by patients make alternative fixation methods desirable. This study biomechanically compared a threaded/barbed bioabsorbable fixation implant made of a copolymer of 82% poly-L-lactic acid and 18% polyglycolic acid with a 1.57-mm Kirschner wire using the devices to fix 2 synthetic bone blocks together. Constructs were evaluated by applying a cantilever load, which simulated a plantar force on the middle phalanx. In all cases, the failure mode was bending of the implant, with no devices fracturing. The stiffness (approximately 6-9 N/mm) and peak load (approximately 8-9 N) of the constructs using the 2 systems were equivalent. Accelerated aging at elevated temperature (47 degrees C) in a buffer solution showed that there was no reduction in mechanical properties of the bioabsorbable system after the equivalent of nearly 6 weeks in a simulated in vivo (37 degrees C) environment. These results suggest that the bioabsorbable implant would be a suitable fixation device for the hammer toe procedure.
Absorbable Implants↗
[Etiology and therapy of clavus and hammer toe].
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Callosities↗