Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciences0869-60472414-3545"Paediatrician" Publishers LLC109610.15690/vramn1096Research ArticleSurgical treatment of hammertoes (literature review)BobrovDmitry S.<p>MD, PhD, Associate Professor</p>dsbmed@mail.ruhttps://orcid.org/0000-0002-1190-7498ShubkinaAlena A.<p>MD, postgraguate</p>alenashubkina@gmail.comhttps://orcid.org/0000-0002-9650-4822LychaginAlexey V.<p>MD, PhD, Professor</p>dr.lychagin@mail.ruhttps://orcid.org/0000-0002-2202-8149SlinyakovLeonid Yu.<p>MD, PhD, Professor</p>slinyakovleonid@mail.ruhttps://orcid.org/0000-0002-1088-5522YakimovLeonid A.<p>MD, Professor</p>dr.yakimov@gmail.comhttps://orcid.org/0000-0001-6272-5048I.M. Sechenov First Moscow State Medical University (Sechenov University)051020197442722821501201903092019Copyright © 2019, "Paediatrician" Publishers LLC2019<p>The high prevalence of hammertoe deformity in the population, the effect of this pathology on the ability and the quality of life allow us to consider this pathology as a important medical problem. The most common surgery is arthrodesis of the proximal interphalangeal joint with a Weil-osteotomy. Specific complication is a floating toe, which leads to overload of adjacent toes and metatarsal heads. For to correct the instability of the metatarsophalangeal joint, the flexor to extensor transfer Girdlestone-Taylor can be used. However, the use of this procedure had limitations associated with difficult surgery techniques and below the average cosmetic result of the procedure. In the study of the causes of hammertoe deformity, the conclusion of the importance of the plantar plate of the metatarsophalangeal joint was made. Plantar plate repair leads to the stabilization of the metatarsophalangeal joint, reduces the risk of developing a floating toe, leads to the restoration of the support function and normal biomechanics of movement and foot function. Simultaneously, the plantar plate repair technically complicates surgical treatment. An promising direction of treatment is minimally invasive technologies for correction of hammertoe deformity that can reduce the risk of infectious complications, improve the cosmetic result of the surgery and reduce the risk of postoperative contracture in the joint, the time of the operation and rehabilitation, postoperative pain, emotional stress for the patient. However, the technique this type of surgery is more difficult, it requires a long training of the surgeon. The potential risk of intraoperative damage to various anatomical structures increases, which requires use of special tools during surgery. The choice of the surgical procedures is based on the individual characteristics of the pathological changes in the patients foot, the equipment of the operating room and the experience of the surgeon. It is necessary to evaluate the elasticity of the deformity, the stability of the metatarsophalangeal joint, the presence and severity of concomitant overloading metatarsalgia, as well as to take into account the subjective personalized requirements and expectations of the patient.</p>hammer toe syndromeminimally invasive surgical proceduresplantar platereview literatureмолоткообразная деформациявосстановление подошвенной связкиминимально инвазивная хирургия[Angirasa AK, Barrett MJ, Silvester D. SmartToe implant compared with Kirschner wire fixation for hammer digit corrective surgery: a review of 28 patients. J Foot Ankle Surg. 2012;51(6):711–713. doi: 10.1053/j.jfas.2012.06.013.][Miller DJ, Throckmorton TW, Azar FM, et al. Business and practice management knowledge deficiencies in graduating orthopedic residents. Am J Orthop (Belle Mead NJ). 2015;44(10):E373–378.][Canales MB, Razzante MC, Ehredt DJ, Clougherty CO. A simple method of intramedullary fixation for proximal interphalangeal arthrodesis. J Foot Ankle Surg. 2014;53(6):817–824. doi: 10.1053/j.jfas.2014.03.017.][Dunn JE, Link CL, Felson DT, et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. 2004;159(5):491–498. doi: 10.1093/aje/kwh071.][Myerson MS, Shereff MJ. The pathological anatomy of claw and hammer toes. J Bone Joint Surg Am. 1989;71(1):45–49. doi: 10.2106/00004623-198971010-00008.][Sarrafian SK, Topouzian LK. Anatomy and physiology of the extensor apparatus of the toes. J Bone Joint Surg Am. 1969;51(4):669–679. doi: 10.2106/00004623-196951040-00005.][Suero EM, Meyers KN, Bohne WH. Stability of the metatarsophalangeal joint of the lesser toes: a cadaveric study. J Orthop Res. 2012;30(12):1995–1998. doi: 10.1002/jor.22173.][Chalayon O, Chertman C, Guss AD, et al. Role of plantar plate and surgical reconstruction techniques on static stability of lesser metatarsophalangeal joints: a biomechanical study. Foot Ankle Int. 2013;34(10):1436–1442. doi: 10.1177/1071100713491728.][O’Kane C, Kilmartin TE. The surgical management of central metatarsalgia. Foot Ankle Int. 2002;23(5):415–419. doi: 10.1177/107110070202300508.][Borchgrevink GE, Finsen V. [Resection of the proximal phalanx in hammertoe. (Article in Norwegian).] Tidsskr Nor Laegeforen. 2010;130(21):2116–2118. doi: 10.4045/tidsskr.09.0882.][Bauman ML, Steiner I, Mandresh RS, Green DR. Bone regeneration in digital surgery. J Am Podiatry Assoc. 1981;71(8):430–435. doi: 10.7547/87507315-71-8-430.][Roukis TS.A 1-piece shape-metal nitinol intramedullary internal fixation device for arthrodesis of the proximal interphalangeal joint in neuropathic patients with diabetes. Foot Ankle Spec. 2009;2(3):130–134. doi: 10.1177/1938640009336199.][Ellington JK, Anderson RB, Davis WH, et al. Radiographic analysis of proximal interphalangeal joint arthrodesis with an intramedullary fusion device for lesser toe deformities. Foot Ankle Int. 2010;31(5):372−376. doi: 10.3113/FAI.2010.0372.][Zelen CM, Young NJ. Digital arthrodesis. Clin Podiatr Med Surg. 2013;30(3):271–282. doi: 10.1016/j.cpm.2013.04.006.][Бобров Д.С., Слиняков Л.Ю., Ригин Н.В. Перегрузочная метатарзалгия: патогенез, биомеханика и хирургическое лечение (аналитический обзор литературы) // Вестник Российской академии медицинских наук. ― 2017. ― Т.72. ― №1. ― С. 53–58. [Bobrov DS, Slinjakov LJ, Rigin NV. The primary metatarsalgia: pathogenesis, biomechanics and surgical treatment. Annals of the Russian Academy of Medical Sciences. 2017;72(1):53–58. (In Russ).] doi: 10.15690/vramn756.][Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency. J Am Acad Orthop Surg. 2014;22(4):235–245. doi: 10.5435/JAAOS-22-04-235.][Soule RE. Operation for the cure of hammer toe. New York Med J. 1910;649−650.][Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000;21(2):94–104. doi: 10.1177/107110070002100202.][O’Kane C, Kilmartin T. Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases. Foot Ankle Int. 2005;26(4):320–325. doi: 10.1177/107110070502600408.][Konkel KF, Menger AG, Retzlaff SA. Hammer toe correction using an absorbable intramedullary pin. Foot Ankle Int. 2007;28(8):916–920. doi: 10.3113/FAI.2007.0916.][Guelfi M, Pantalone A, Daniel JC, et al. Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options Journal of Orthopaedics and Traumatology. 2015;16(4):269–273. doi: 10.1007/s10195-015-0360-0.][Galli MM, Brigido SA, Protzman NM. Pinning across the metatarsophalangeal joint for hammertoe correction: where are we aiming and what is the damage to the metatarsal articular surface? J Foot Ankle Surg. 2014;53(4):405–410. doi: 10.1053/j.jfas.2013.06.014.][Boffeli TJ, Thompson JC, Tabatt JA. Two-pin fixation of proximal interphalangeal joint fusion for hammertoe correction. J Foot Ankle Surg. 2016;55(3):480–487. doi: 10.1053/j.jfas.2016.01.027.][Dayton P, Smith D. Dorsal suspension stitch: an alternative stabilization after flexor tenotomy for flexible hammer digit syndrome. J Foot Ankle Surg. 2009;48(5):602–605. doi: 10.1053/j.jfas.2009.05.014.][Caterini R, Farsetti P, Tarantino U, et al Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity. Foot Ankle Int. 2004;25(4):256–261. doi: 10.1177/107110070402500411.][Catena F, Doty JF, Jastifer J. Prospective study of hammertoe correction with an intramedullary implant. Foot Ankle Int. 2014;35(4):319–325. doi: 10.1177/1071100713519780.][Петросян А.С., Загородний Н.В., Процко В.Г., и др. Эндопротезирование проксимальных межфаланговых суставов при молоткообразной деформации пальцев стопы // Травматология и ортопедия России. ― 2012. ― №2. ― С. 54–59. [Petrosyan AS, Zagorodniy NV, Protsko VG, et al. Replacement of proximal interphalangeal joints in hammer toe deformity. Travmatologiya i ortopediya Rossii. 2012;(2):54–59. (In Russ).]][Kominsky SJ, Bermudez R, Bannerjee A. Using a bone allograft to fixate proximal interphalangeal joint arthrodesis. Foot Ankle Spec. 2013;6(2):132–136. doi: 10.1177/1938640013480237.][Coillard JY, Petri GJ, van Damme G, Deprez P, Laffenêtre OA, Stabilization of Proximal Interphalangeal Joint in Lesser Toe Deformities With an Angulated Intramedullary Implant. J Foot Ankle Int. 2014;35(4):401–407. doi: 10.1177/1071100713519601.][Ellington JK, Anderson RB, Davis WH, et al. Radiographic analysis of proximal interphalangeal joint arthrodesis with an intramedullary fusion device for lesser toe deformities. Foot Ankle Int. 2010;31(5):372–376. doi: 10.3113/FAI.2010.0372.][Konkel KF, Sover ER, Menger AG, Halberg JM. Hammer toe correction using an absorbable pin. Foot Ankle Int. 2011;32(10):973–978. doi: 10.3113/FAI.2011.0973.][Kramer WC, Parman M, Marks RM. Hammertoe correction with k-wire fixation. Foot Ankle Int. 2015;36(5):494–502. doi: 10.1177/1071100714568013.][Trnka HJ, Gebhard C, Mühlbauer M, et al. The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies. Acta Orthop Scand. 2002;73(2):190–194. doi: 10.1080/000164702753671795.][Highlander P, Von Herbulis E, Gonzalez A, et al. Complications of the Weil osteotomy. Foot Ankle Spec. 2011;4(3):165–170. doi: 10.1177/1938640011402822.][Hofstaetter SG, Hofstaetter JG, Petroutsas JA, et al. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br. 2005;87(11):1507–1511. doi: 10.1302/0301-620X.87B11.16590.][Gregg J, Silberstein M, Clark C, Schneider T. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot and Ankle Surgery. 2007;13(3):116–121. doi: 10.1016/j.fas.2007.01.001.][Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int. 2012;33(2):133–140. doi: 10.3113/FAI.2012.0133.][Cook JJ, Johnson LJ, Cook EA. Anatomic reconstruction versus traditional rebalancing in lesser metatarsophalangeal joint reconstruction. J Foot Ankle Surg. 2018;57(3):509–513. doi: 10.1053/j.jfas.2017.11.023.][Nery C, Coughlin MJ, Baumfeld D, Mann TS. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int. 2012;33(4):301–311. doi: 10.3113/FAI.2012.0301.][Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg. 2008;47(2):125–137. doi: 10.1053/j.jfas.2007.12.008.][Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg. 1998;37(3):217–222. doi: 10.1016/s1067-2516(98)80114-2.][Cooper MT, Coughlin MJ. Sequential dissection for exposure of the second metatarsophalangeal joint. Foot Ankle Int. 2011;32(3):294–299. doi: 10.3113/FAI.2011.0294.][Barbari SG, Brevig K. Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. Foot Ankle. 1984;5(2):67–73. doi: 10.1177/107110078400500204.][Trethowen WH. Treatment of hammertoe. Lancet. 1925;1312−1313.][Girdlestone GR. Physiotherapy for hand and foot. Physiotherapy. 1947;32(11):167–169.
][Parrish TF. Dynamic correction of clawtoes. Orthop Clin North Am. 1973;4(1):97–102.][Taylor RG. The treatment of claw toes by multiple transfers of flexor into extensor tendons. J Bone Joint Surg Br. 1951;33-B(4):539–542. doi: 10.1302/0301-620x.33b4.539.][Sgarlato TE. Transplantation of the flexor digitorum longus muscle tendon in hammertoes. J Am Podiatry Assoc. 1970;60(10):383–388. doi: 10.7547/87507315-60-10-383.][Mendicino RW, Statler TK, Saltrick KR, Catanzariti AR. Predislocation syndrome: a review and retrospective analysis of eight patients. J Foot Ankle Surg. 2001;40(4):214–224. doi: 10.1016/s1067-2516(01)80021-1.][Myerson MS, Jung HG. The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. Foot Ankle Int. 2005;26(9):675–679. doi: 10.1177/107110070502600903.][Boyer ML, De Orio JK. Transfer of the flexor digitorum longus for the correction of lesser-toe deformities. Foot Ankle Int. 2007;28(4):422–430. doi: 10.3113/FAI.2007.0422.][Iglesias ME, Vallejo RB, Jules KT, Trepal MJ. Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities. J Am Podiatr Med Assoc. 2012;102(5):359–368. doi: 10.7547/1020359.][Roukis TS, Schade VL. Minimum-incision metatarsal osteotomies. Clin Podiatr Med Surg. 2008;25(4):587–607. doi: 10.1016/j.cpm.2008.05.007.][White DL. Minimal incision approach to osteotomies of the lesser metatarsals. For treatment of intractable keratosis, metatarsalgia, and tailor’s bunion. Clin Podiatr Med Surg. 1991;8(1):25–39.][Бережной С.Ю., Буриев И.М. Чрескожная хирургия центральных статических метатарсалгий // Вестник Национального медикохирургического центра им. Н.И. Пирогова. ― 2012. ― Т.7. ― №3. ― С. 50−53. [Berezhnoi SYu, Buriev IM. Distal percutaneous metatarsal osteotomy in the treatment of central static metatarsalgias. Vestnik Natsional’nogo medikokhirurgicheskogo tsentra im. N.I. Pirogova. 2012:7(3):50−53. (In Russ).]][Van Enoo RE, Cane EM. Minimal incision surgery. A plastic technique or a cover-up? Clin Podiatr Med Surg. 1986;3(2):321–335.][Gilheany M, Baarini O, Samaras D. Minimally invasive surgery for pedal digital deformity: an audit of complications using national benchmark indicators. J Foot Ankle Res. 2015;8:17. doi: 10.1186/s13047-015-0073-x.][Bauer T. Percutaneous forefoot surgery. Orthop Traumatol Surg Res. 2014;100(1 Suppl):S191–204. doi: 10.1016/j.otsr.2013.06.017.][Redfern D, Vernois J, Legré BP. Percutaneous surgery of the forefoot. Clin Podiatr Med Surg. 2015;32(3):291–332. doi: 10.1016/j.cpm.2015.03.007.][Redfern DJ, Vernois J. Percutaneous surgery for metatarsalgia and the lesser toes. Foot Ankle Clin. 2016;21(3):527–550. doi: 10.1016/j.fcl.2016.04.003.]