Abstract
Category:
Lesser Toes; Midfoot/Forefoot
Introduction/Purpose:
Hammertoes and other lesser toe deformities represent extremely common foot problems, affecting nearly one-third of the general population. When surgery is indicated, correction of these deformities has traditionally been described using a PIP arthroplasty technique with a smooth, temporary Kirschner-wire for fixation. This method can produce excellent results, but there are well-described risks including deformity recurrence, secondary deformities, painful nonunion, and pin tract infections. Our goal is to describe a more modern technique that includes preparation and arthrodesis of both the PIP and DIP joints with intramedullary screw fixation.
Methods:
A retrospective chart review was conducted at one tertiary referral center of patients who underwent correction of lesser toe deformity between 2017 and 2021. Inclusion criteria were patient age greater than 18, use of the PIPA/DIPA technique with screw, and a minimum 10 weeks of follow up with radiographs. Charts were reviewed for patient demographics, comorbidities, preoperative characteristics, and postoperative complications. Our primary outcome variable was deformity correction achieved and maintained at minimum 10 weeks postoperatively based on both chart review and radiographs. Secondary outcomes included hardware failure, infection, vascular complication, screw removal for any reason, nonunion, and amputation.
Results:
129 patients and 374 operative toes were identified on chart review and met inclusion criteria. Of these patients, 370 toes (98.9%) maintained deformity correction both clinically and radiographically at 10 weeks and did not undergo revision surgery. 17 toes (4.5%) required screw removal for any reason. 3 toes (0.8%) experienced deep infection, and 1 patient experienced superficial infection that resolved with oral antibiotic treatment. Furthermore, in addition to a concomitant deep infection, one toe experienced vascular compromise and required amputation. There were no symptomatic nonunions, and there were 7 (1.8%) asymptomatic nonunions as seen on radiographs.
Conclusion:
With respect to previously and classically described methods of lesser toe deformity correction, the PIPA/DIPA technique with a retrograde screw presents an acceptable and safe method for sustained deformity correction.