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Published bySandra Bailey Modified over 9 years ago
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Feet – Hallux Valgus, Claw & Hammer Toes and Mortons Neuroma’s
Neil Davies Consultant Orthopaedic Surgeon October 2004
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Hope to Cover! Definition Aetiology
Pathology / muscle function / anatomy Treatment Outcomes
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Hallux Valgus & Bunions
Bunio – to enlarge Common Unclear cause Female predominant Barefoot protection Degenerative Acquired Familial Hypermobile 1st MTC Metatarsus Primus Varus Hyperpronated 1st Ray Medial slanted 1st MTC
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Choo – Blahniks Disease!
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Footwear
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Pathology Lateral deviation of hallux Medial bunion
Metatarsus primus varus Sesamoid subluxation Pronation of the hallux
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Signs and Symptoms Asymptomatic Pain Tenderness Infection Aesthetic
‘It might get worse’
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Signs
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Radiologically 15 10 9
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Move Over Jimmy Choo
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Differentials
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Non Operative Measures
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Surgery Wilsons McBride Modified McBride Kellers Chevron Silver SCARF
Akin Basal Opening Wedge BRT Arthrodesis
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Post Operative Stable osteotomy Heel weight bear Flexible correction
Light dressing Back to work
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Outcomes of surgery Stable 70-80% satisfaction Good correction
Low risk AVN Low risk # Poor for the Juvenile Contra indications – Spasticity Equinus contracture Marfans Vascular insufficiency Short 1st Metatarsal
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Hammer Toe
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Normal Toe Positioning
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In Shoes!
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Hammer Toe
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Incidence Incidence 2-20% population Female : male = 4:1
Mallet:Hammer = 1:9 Increase at years old
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Hammer Toe - causes Multifactorial Footwear
Trauma - compartment syndrome (tight FDL - dynamic) Muscle imbalance - Friedreich’s, C.P, M.S, Myelodysplasia, degenerative disk disease Diabetes Hansen’s disease RA/Psoriatic arthropathy
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Long Toes - Mallet/Hammer
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Treatment - Hammer Flexible Rigid MTP hyperextension FDL tight
Associated H/Valgus
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Treatment - Hammer
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Treatment - surgical DuVries arthroplasty - rigid F.E.T.T - flexible
Partial phalangectomy & syndactylisation Amputation Silicon arthroplasty
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DuVries Arthroplasty
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DuVries Arthroplasty
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Post Operative Care Compression bandage Mobilise in cast R/O wire 3/52
Support toe further 4/52
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Treatment - Dynamic Hammer
Flexible/Dynamic deformity FDL contracture Only present on standing Treat by FDL tendon transfer
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Flexor to Extensor Tendon Transfer
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Flexor to Extensor Tendon Transfer
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Flexor to Extensor Tendon Transfer
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Results High Fusion - bony/fibrous 50-80% satisfactory
Excellent pain relief 54% correction of MTP subluxation
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Complications Swelling Transient numbness PIP joint stiffness
Residual angulation Continuing pain Pin tract infection MTP hyperextension Moulding
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Claw Toes
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Claw Toes - causes Unclear Associated with muscle imbalance RA
Collagen deficiency syndromes Cavus foot Idiopathic
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Muscle Action - at rest
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Muscle Action - EDL
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Muscle Action - FDL
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Muscle Action - EDL/FDL
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Clinical Examination Neurological Vascular Flexible/ Rigid Callosity
Nail problems Space locally
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Radiological Assessment
Bony deformity seen Subluxation or dislocation Gun Barrel Sign
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Claw Toes
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Treatment - Claw Toes Depends on pathology, i.e. cavus Conservative
Surgical Again flexible/rigid Treat both Hammer and MTP joint components
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Treatment - Claw Toe
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Results & Complications - Claw
70-90% Fair/good post operation Recurrence of deformity a problem Persistent metatarsalgia
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Mortons/Interdigital Neuroma
Difficult to diagnose Pain into toes Aggrevated by activity Tingling in toes Non descript burning Metatarsalgia Stress # MT bursae
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Morton’s 45% 25%
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Mulders Click
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Ultrasound in Mortons
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Diagnosis & Treatment Clinical USS LA injection MRI Wide fitting shoes
Many settle Steroid Excision Neurolysis Intermetatarsal release
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Outcomes Dependant on diagnosis 80% satisfaction
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