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

2. 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

3. Preoperative x-rays
Irreducible 2nd MTPJ require

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

5. Preoperative x-rays

6. 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

7. 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……

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

9. 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

10. Preoperative
1 year postoperative

11. 1 year postoperative
2nd MTPJ ruptured, FDL also incompetent—tendons ruptured or dorsally subluxed

12. 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