Gait Analysis of the Donor Foot in Microsurgical Reconstruction of the Thumb

Abstract

Clinical and step evaluations by a piezoelectric system board were performed in 54 patients who underwent microsurgical reconstruction of the thumb by great or second toe transfer. Forty-four patients were male and 10 were female. In 13 cases, the thumb was reconstructed by the Morrison wrap-around technique. In 27 cases, an extended variant of the Morrison technique was used in which the whole distal phalanx was harvested with skin and nail apparatus. Four patients were treated by great toe transfer and 10 were treated by second toe transfer. Follow-up ranged from 2 to 144 months.

The group of patients treated by the wrap-around technique presented hallux rigidus in 38.5% of cases. The group of patients treated by the extended variant of the Morrison technique presented a lesser tendency to hallux rigidus but a clear reduction of the pushing phase of hallux. The group of patients treated by second toe transfer presented a third and fourth metatarsal bone overload that was confirmed by a statistical Wilcoxon test: overload was linked to a plantar hyperkeratosis at the third metatarsal (20%), fourth metatarsal (10%), or fifth metatarsal bone (20%). A claw deformity of the third and fourth toes was observed in 20% of these patients. The four patients who underwent microsurgical reconstruction of the thumb by great toe transfer exhibited an overload of central and lateral metatarsal bones.

Second toe transfer is not associated with the functional or cosmetic changes seen in great toe transfer and is therefore preferred.

The cosmetic and functional results from extended great toe transfer make this a much less desirable transfer than the wrap-around or modified wrap-around technique. The transfer with the least donor site problem is second toe to thumb.