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Surgical Correction of Hammertoes. What are Hammertoes? Classic Hammertoe –MPJ is...

Date post:16-Dec-2015
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  • Slide 1
  • Surgical Correction of Hammertoes
  • Slide 2
  • What are Hammertoes? Classic Hammertoe MPJ is cocked upward and PIPJ is downward Claw Toe MPJ is upward, PIPJ and DIPJ are downward Mallet Toe DIPJ is downward
  • Slide 3
  • What Causes Hammertoes? Hammertoes are primarily caused by a muscle imbalance during gait There is also evidence that poor fitting shoes can contribute
  • Slide 4
  • Muscles Involved Extrinsic Muscles: Flexor Digitorum Longus Extensor Digitorum Longus Flexor Hallucis Longus Extensor Hallucis Longus Tibialis Anterior Tibialis Posterior Peroneus Longus Peroneus Brevis Intrinsic Muscles Lumbricales Plantarflexory force across MPJ/Proximal phalanx Quadratus Plantae Interossei Plantarflexory force across MPJ, stabilization in transverse plane Extensor Digitorum Brevis Flexor Digitorum Brevis
  • Slide 5
  • Slide 6
  • Gait Patterns Flexor Stabilization Most common, FDL/FDB overpower the interossei Flexor Substitution Caused by weak Tendo-Achilles where PB, PL, TP, FDL, FHL try to make up for the weak calf muscles and again overpower the interossei Extensor Substitution EDL overpowers the lumbricales, usually seen in high arched foot and/or ankle equinus
  • Slide 7
  • How do we Treat Crooked Toes? We can try to accommodate the hammertoes with non- surgical treatment such as: Orthotics Metatarsal pads Soft toe caps Wide, Extra-depth shoes Digital spacers Taping/Splinting Crest Pads
  • Slide 8
  • When non-surgical methods fail, we start thinking about surgical options. We need to decide what techniques and products work best for our patients. So whats out there
  • Slide 9
  • Smooth K-Wire Advantages: Quick application Cheap Able to cross the MPJ if needed Disadvantages: Pin is sticking out of toe and can catch on things No compression Increased risk of infection Toe can rotate Wire can bend
  • Slide 10
  • Screw Fixation Advantages: Not sticking out of skin Provides compression Disadvantages: Toe is completely straight and cant bend at DIPJ Can still rotate More difficult to remove than a wire if needed
  • Slide 11
  • Absorbable Pins Advantages: Internal Cost efficient Disadvantages: No compression Toe can rotate Patient can have a reaction to the material
  • Slide 12
  • Stay Fuse Advantages: Internal Provide some compression Different sizes Disadvantages: 2 pieces Costly Higher chance for error
  • Slide 13
  • Slide 14
  • Biomet Weil-Carver Implant Advantages: Resorbable with Lactosorb: poly-L-lactic/polyglycolic acid copolymer Retains strength 6-8wks, degrades approx 12 mos Partially threaded, barbed to prevent pistoning Disadvantages: Toe can still rotate Doesnt provide complete compression
  • Slide 15
  • Slide 16
  • Smart Toe Advantages: Internal Provides some compression Prevents rotation Also comes with an angled version Disadvantages: Must be cooled prior to implantation Costly
  • Slide 17
  • X Fuse Advantages and Disadvantages comparable to the Smart Toe
  • Slide 18
  • Orthopro I Fuse New product in development Comes in Screw-Barb and Barb-Barb configurations Small and Large sizes Also comes either angled at 10 degrees or straight
  • Slide 19
  • Screw-Barb Configuration
  • Slide 20
  • Barb-Barb Configuration
  • Slide 21
  • Pins
  • Slide 22
  • Broach with AO Quick Connect
  • Slide 23
  • Drivers
  • Slide 24
  • Implant in Bone Model
  • Slide 25
  • Summary As reps you have more influence on doctors than you know.However: Once you can get surgeons to break out of their old habits they will: 1. Use the quickest implant to insert. 2. The implant that has minimal complications, high fusion rate and high patient satisfaction. Note: In my opinion, the best implant as far as a rep is concerned is one that has a high degree of dummy factor. If the implant is easy to put in: ie. Doesnt require dry ice etc. then the rep doesnt have to be present for every case. (Earning income while golfing)

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