eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Claw Toe: Follow-up

Author: James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
Contributor Information and Disclosures

Updated: Feb 28, 2009

Outcome and Prognosis

The experiences of other authors indicate that complete correction of the toe is necessary to achieve the best result. Of course, this presumes careful attention to detail and a toe with normal vascularity. Taylor18,19 and Pyper,23 via transfer of both the long and short flexor to the extensor hood without bony resection, achieved only 72% and 51% good results, respectively. Pyper also noted that with soft-tissue procedures alone, the deformity recurred and results were somewhat unpredictable. Therefore, Frank and Johnson24 and McCluskey et al25 recommend PIP resection along with soft tissue procedures to realign the toe.

Barbari and Brevig26 reviewed 31 patients who had surgery on multiple toes. These authors concluded that the best cosmetic results were achieved in younger patients, and they noted that active or passive motion in the interphalangeal joints was present in 60% of these cases. Of course, restriction in range of motion is an intended outcome of the procedure. Patients must be aware that in most instances, they will sacrifice prehensile action of the toe for less pain, will have better shoe-wearing capabilities, and, ideally, will have an improved cosmetic result. Specific disease entities seem to fare similarly; Cyphers and Feiwell27 reported 60% good results in patients with myelomeningocele.

Future and Controversies

A future prospective study that separates claw toes from hammer toes, fixed from flexible, severe from mild, and bony correction (ie, PIP and metatarsal neck osteotomies) from soft-tissue procedures alone is necessary. The addition of an extensor tendon transfer beneath the intermetatarsal ligament with reattachment to the proximal phalanx may help improve continued deformity at the time of surgery or recurrent postoperative dorsiflexion deformity.

When to perform each of the procedures on a claw toe and the extent of the surgical procedure on a single toe remain controversial. Other controversies are a bolster suture above the PIP joint in lieu of a pin, the size of the toe fixation pin, the duration it needs to remain in place, and whether or not it needs to cross the MTP joint.

 


More on Claw Toe

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Workup: Claw Toe
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Follow-up: Claw Toe
Multimedia: Claw Toe
References
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References

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  3. Coughlin MJ, Mann RA. Lesser toe deformities. In: Mann RA, ed. Surgery of the Foot and Ankle. 7th ed. St. Louis, Mo: Mosby; 1999:320-91.

  4. Mann R, Coughlin M. Lesser toe deformities. In: Jahss M, ed. Disorders of the Foot and Ankle. Philadelphia, Pa: WB Saunders; 1991:1208-9.

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  18. Taylor RG. The treatment of claw toes by multiple transfers of flexor into extensor tendons. J Bone Joint Surg. 1951;33B:539-542.

  19. Taylor RG. The treatment of claw toes by multiple transfers of flexor into extensor tendons. J Bone Joint Surg Br. Nov 1951;33-B(4):539-42. [Medline].

  20. Steensma MR, Jabara M, Anderson JG, Bohay DR. Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint. Foot Ankle Int. Sep 2006;27(9):689-92. [Medline].

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Further Reading

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Keywords

lesser toe deformity, hammertoe, hammer toe, curly toe, mallet toe, toe deformity, toe disorders, foot disorders, metatarsalgia, metatarsophalangeal joint flexibility, MTP joint flexibility, proximal interphalangeal joint flexibility, PIP joint flexibility, distal interphalangeal joint flexibility, DIP joint flexibility, PIP flexibility, DIP flexibility, MTP flexibility, toe calluses, toe erythema

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Contributor Information and Disclosures

Author

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Medical Editor

John S Early, MD, Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship Baylor University Medical Center
John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Zimmer Inc Consulting fee Consulting; Smith Nephew Consulting fee Consulting; AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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