Workup
Laboratory Studies
The only laboratory studies needed are standard preoperative tests.
Next:
Imaging Studies
Standard anteroposterior (AP), lateral, and oblique weightbearing radiographs are obtained as part of the initial workup. (See the images below.) Lesion markers can be applied over the hard and soft corns to help identify the correct underlying condyle. AP and oblique views readily show exostosis, enlarged condyles, and varus deformity of the toe. The lateral view is helpful in identifying the severity of the dorsal and plantar contractures at the metatarsophalangeal (MTP) joint (MTPJ) and the proximal interphalangeal (PIP) joint (PIPJ).
Fifth-toe deformities. This radiograph shows prominent fifth-toe proximal phalanx medial condyle contacting base of proximal phalanx on fourth toe, creating increased pressure and interdigital clavi.
Fifth-toe deformities. This radiograph shows distal phalanx of varus-rotated fifth toe contacting proximal phalanx on fourth toe, creating another area of increased pressure and interdigital clavi.
Previous
Media Gallery
-
Fifth-toe deformities. Example of hard corn. They commonly occur on dorsal lateral aspect of proximal interphalangeal joint but can also occur in same location over distal interphalangeal joint.
-
Fifth-toe deformities. Example of soft corn deep in web space. Intrinsic pressure develops between adjacent condyles of lateral fourth proximal interphalangeal (PIP) joint (PIPJ) abutting medial fifth distal interphalangeal (DIP) joint (DIPJ), or lateral fourth metatarsophalangeal (MTP) joint MTPJ) abutting medial fifth PIPJ. Lesions can develop on skin over lateral fourth PIPJ, medial fifth DIPJ, medial fifth PIPJ, or deep in web space.
-
Fifth-toe deformities. This image and image below are examples of kissing corns. They are two calluses that rub against each other on adjacent toes and are usually painful when squeezed together.
-
Fifth-toe deformities. Example of kissing corn. These corns are two calluses that rub against each other on adjacent toes and are usually painful when squeezed together.
-
Fifth-toe deformities. This image and image below are further examples of kissing corns. Maceration is often noted in web space and may contribute to their development. When they occur, other common problems, such as fungal infections or verruca, must be ruled out. These lesions may develop into ulcerations in neuropathic population if untreated, as is seen in this case.
-
Fifth-toe deformities. Example of kissing corns. Maceration is often noted in web space and may contribute to their development. When they occur, other common problems, such as fungal infections or verruca, must be excluded. These lesions may develop into ulcerations in neuropathic population if untreated, as is seen in this case.
-
Fifth-toe deformities. Example of hammertoe with dorsiflexion contracture at metatarsophalangeal joint and plantarflexion contracture at proximal interphalangeal joint. Note irritated skin secondary to shoe pressure.
-
Fifth-toe deformities. This image and image below represent an overlapping fifth toe. It is dorsally hyperextended at metatarsophalangeal (MTP) joint (MTPJ) with varus rotation and medial deviation onto top of fourth digit. Contractures develop dorsomedially at MTPJ and eventually form in extensor digitorum longus tendon and dorsomedial skin overlying MTPJ.
-
Fifth-toe deformities. Overlapping fifth toe is dorsally hyperextended at metatarsophalangeal (MTP) joint (MTPJ) with varus rotation and medial deviation onto top of fourth digit. Contractures develop dorsomedially at MTPJ and eventually form in extensor digitorum longus tendon and dorsomedial skin overlying MTPJ.
-
Fifth-toe deformities. This image and image below are examples of underlapping fifth toe, or curly toe. It is plantarflexed at metatarsophalangeal (MTP) joint (MTPJ), rotated into varus position, and positioned under fourth digit. Contracture typically occurs at the plantar-medial MTPJ capsule and flexor digitorum longus tendon.
-
Fifth-toe deformities. Underlapping fifth toe, or curly toe. It is plantarflexed at metatarsophalangeal (MTP) joint (MTPJ), rotated into varus position, and positioned under fourth digit. Contracture typically occurs at plantar-medial metataMTPJ capsule and flexor digitorum longus tendon.
-
Fifth-toe deformities. This radiograph shows prominent fifth-toe proximal phalanx medial condyle contacting base of proximal phalanx on fourth toe, creating increased pressure and interdigital clavi.
-
Fifth-toe deformities. This radiograph shows distal phalanx of varus-rotated fifth toe contacting proximal phalanx on fourth toe, creating another area of increased pressure and interdigital clavi.
-
Fifth-toe deformities. This image and following three images demonstrate surgical course for severe fifth digit cock-up deformity. Note dorsal contracture in this preoperative photo.
-
Fifth-toe deformities. Planned incision with arms for Z-plasty skin-lengthening flap drawn in. Central arm of Z-plasty is along line of skin contracture.
-
Fifth-toe deformities. Exposure showing severely contracted extensor digitorum longus tendon. This is lengthened during procedure.
-
Fifth-toe deformities. Postoperative photo showing corrected fifth digit.
-
Fifth-toe deformities. This image and following images demonstrate operative technique for painful overlapping fifth-toe deformity.
-
Fifth-toe deformities. Painful overlapping fifth-toe deformity.
-
Fifth-toe deformities. When toe is derotated and plantarflexed into correct position, dorsal skin "tents up," showing exact location of skin contracture.
-
Fifth-toe deformities. In this case, Z-plasty is performed to lengthen contracted skin. Length is achieved along central arm of the "Z" so it is placed along the line of contracture. Adjunctive procedures such as metatarsophalangeal joint release and extensor digitorum longus tendon lengthening should be performed through same incision. Alternative to Z-plasty is V-Y flap.
-
Fifth-toe deformities. After rotation of Z flaps and soft-tissue release, toe is reevaluated. Toe is down, and proximal phalanx is in excellent position, but distal portion of toe has varus rotation at proximal interphalangeal (PIP) joint (PIPJ). PIPJ arthroplasty with derotational skin plasty is then performed to address this portion of deformity.
-
Fifth-toe deformities. This image and image below were taken 5 days postoperatively with contractures addressed and toe in good position.
-
Fifth-toe deformities. Five days after surgery, contracture is addressed and toe is in good position.
of
24
