HAMMER CLAW MALLET TOE SURGERY

Hammer, claw, and mallet toe surgery refers to a series of surgical procedures performed to correct deformed toes. Purpose
There are three main forms of toe abnormalities in the human foot: hammer toes, claw toes, and mallet toes. A hammer toe, also called contracted toe, bone spur, rotated toe, or deformed toe, is a toe curled as the result of a bend in the middle joint. It may be either flexible or rigid, and may affect any of the four smaller toes. The joints in the toe buckle due to tightening of the ligaments and tendons, which points the toe upward at an angle.

The patient’s shoes then put pressure on the prominent portion of the toe, leading to inflammation, bursitis, corns, and calluses. Mallet toes and claw toes are similar to hammer toes, except that different joints on the toe are affected. The joint at the end of the toe buckles in a mallet toe, while a claw toe involves abnormal positions of all three joints in the toe.

Toe deformities are caused by a variety of factors:
• Genetic. All three toe deformities may be hereditary.
• Poorly fitted shoes. Claw toes are usually the result of wearing shoes that are too short. Many people have second toes that are longer than their big toes; if they wear shoes sized to fit the big toe, the second toe has to bend to fit into the shoe. High-heeled shoes with pointed toes are also a major cause of claw toes.
• Bunions. A bunion is an abnormal prominence of the first joint of the big toe that pushes the toe sideways toward the smaller toes. Hammer toes often develop together with bunion deformities, and they are often treated together.
• Flat feet. This condition is due to poor biomechanics of the foot and may lead to hammer toes.
• Highly arched feet.
• Rheumatoid arthritis.
• Tendon imbalance. When the foot cannot function normally, the tendons may stretch or tighten to compensate and lead to toe deformities.
• Traumatic injuries of the toes.

When the toe deformity is painful or permanent, surgical repair is performed to relieve pain, correct the problem, and provide a stable, functional toe.

Demographics
As of 2002, the incidence of claw and hammer toe deformities ranges from 2–20% of the population in the United States, with the frequency gradually increasing in the older age groups. Claw and hammer toes are most often seen in patients in the seventh and eight decades of life. Women are affected four to five times more often than men. Little is known about the incidence of these deformities among people who usually wear sandals or go barefoot.

Description
Some of the most common surgical procedures used to repair hammer, claw, and mallet toes include:
• Tenoplasty and capsulotomy. These procedures release or lengthen tightened tendons and ligaments that have caused the toe joints to contract. In some patients with flexible hammer toes, the toe straightens out after these soft tissue structures are lengthened or relaxed.

• Tendon transfer. This procedure is used to correct a flexible hammer toe deformity. It involves the repositioning of a tendon to straighten the toe.

• Bone arthroplasty. In this procedure, the surgeon removessome bone and cartilage to correct the toe deformity. A small segment of bone is removed at the joint to eliminate pressure on the toe, relieve pain, and straighten the toe. The tendons and ligaments surrounding the joint may also be reconstructed.

• Derotation arthroplasty. In this technique, the surgeon removes a small wedge of skin and realigns the deformed toe. The surgeon may also remove a small section of bone, and repair tendons and ligaments if necessary.

• Implant arthroplasty. In this procedure, the surgeon inserts a silicone rubber or metal implant specially designed for the toe to replace the gliding surfaces of the joint and act as a joint spacer.

Diagnosis/Preparation
Patients usually consult a doctor about toe deformities because of pain or discomfort in the foot when walking or running. The physician takes several factors into consideration when examining a patient who may require surgery to correct a toe deformity. Some surgical procedures require only small amounts of cutting or tissue removal while others require extensive dissection. The blood supply in the affected toe is an important factor in planning surgery.

It determines not only whether the toe will heal fully but also whether the surgeon can perform more than one procedure on the toe. In addition to a visual examination of the patient’s foot, the doctor will ask the patient to walk back and forth in the office or hallway in order to evaluate the patient’s gait (habitual pattern of walking). This part of the office examination allows the doctor to identify static or dynamic forces that may be causing the toe deformity. Imaging tests are also performed, usually x-ray studies.

If the doctor considers it necessary to rule out systemicdisorders, he or she may order the following laboratory tests: a fasting glucose test to evaluate or rule out diabetes, and a sedimentation rate test to evaluate the possibility of an underlying infection in the foot. Before surgery, the patient receives an appropriate local anesthetic, and the foot is cleansed and draped.