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Toe Deformities

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Toe Deformities

WHAT IS IT?

There are different types of deformities of what are called the minor toes of the feet – that is to say, from the second to the fifth toe – and while all of them are commonly known as “hammer toe”, they are specifically distinguished as follows:

  • Hammer toe: Hyperflexion of the proximal interphalangeal joint of the toe, with hyperextension of the metatarsal phalangeal and distal interphalangeal joints.
  • Claw toe: Also known as swan-neck deformity, it is the hyperflexion of the proximal and distal interphalangeal joints of the toe, with hyperextension of the metatarsal phalangeal
  • Mallet toe: Hyperflexion of the distal interphalangeal joint of the toe.
  • Clinodactyly: Medial or lateral deviation of the toe.

They may be congenital in nature, but more often they are deformities acquired along with metatarsalgias due to first ray insufficiency. They can also be neurological in origin, such as high arches, paresis, etc.

SYMPTOMS

Besides the anatomical alteration specific to the type of deformity and the metatarsalgia it often accompanies, there also tends to be hyperkeratosis or hard skin in areas that rub most.

TREATMENT

Conservative treatment is based, in the very first stages and if the deformity is reducible, on avoiding tight or pointed footwear, and actively and passively improving the mobility of the toes and using orthopedic devices which aim to reduce the deformity. Unfortunately, in most cases, the deformities are not reducible and orthopedic devices of different compositions and morphologies merely serve to protect the areas that undergo rubbing.

If the patient cannot tolerate the deformity, surgical treatment is recommended. Depending on the type of deformity, different surgical techniques will be applied, such as tenotomy, phalange osteotomy, capsulotomy and arthrodesis among others. These procedures may be percutaneous or open.

For minor and less rigid deformities, percutaneous operations are favoured, reserving open operations for more serious, more rigid deformities or those in which the toe needs to be shortened. On occasion, it is necessary to insert wires, also known as Kirschner needles, which are placed through all of the phalanges of the toe on a provisional basis. Afterwards, it is necessary to remove these needles. This process is carried out on an outpatient basis, three to four weeks after the operation.

The use of PRGF®-Endoret® plasma rich in growth factors helps the consolidation of the surgical techniques applied and reduces the postoperative inflammatory reaction.


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