Hallux valgus AOTrauma—Foot & Ankle Module 15: The lesser toes Christy Kabbash, US

Case description 62-year-old woman with hallux valgus and a painful dorsally dislocated second rigid crossover hammertoe Hallux valgus is not painful; second toe is painful No success with wide, high toe box shoes Unable to splint the second toe, as it is irreducible at the MTP joint and rigid at the PIP Unable to actively flex or plantar flex the second toe

Preoperative x-rays Irreducible 2nd MTPJ require

Preoperative x-rays Irreducible 2nd MTPJ requires a shortening Weil osteotomy to reduce the toe

Preoperative x-rays

Plan In order to fix the hammertoe, the bunion must be addressed Options: Proximal metatarsal osteotomies First TMT fusion/lapidus She has a large IM angle as well as a MTP joint angle Hypermobile Options: Proximal metatarsal osteotomies First TMT fusion/lapidus She has a large IM angle as well as a MTP joint angle Hypermobile

Plan In order to fix the hammertoe, the second ray must be shortened to allow reduction One of the risks of a Weil osteotomy is a floating toe……

Plan Prevention of a floating toe Girdlestone: Requires intact, functioning FDL Active transfer Plantar plate repair

Preoperative 1 year postoperative LAPIDUS —risk of shortening the 1st MT further and “lengthening” the 2nd MT; plantar flexion to equalize weight bearing to avoid this Weil—shorten MT head and tighten plantar plate—repair directly to base of 2nd toe proximal phalanx

Preoperative 1 year postoperative

1 year postoperative 2nd MTPJ ruptured, FDL also incompetent—tendons ruptured or dorsally subluxed

Take-home messages In order to correct a hammer toe deformity of the second toe, correct hallux deformity Girdlestone-Taylor transfer as a flexible alternative to fusion or resection arthroplasty Add plantar plate repair for instability