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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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Presentation on theme: "Feet – Hallux Valgus, Claw & Hammer Toes and Mortons Neuroma’s Neil Davies Consultant Orthopaedic Surgeon October 2004."— Presentation transcript:

1 Feet – Hallux Valgus, Claw & Hammer Toes and Mortons Neuroma’s Neil Davies Consultant Orthopaedic Surgeon October 2004

2 Hope to Cover! Definition Aetiology Pathology / muscle function / anatomy Treatment Outcomes

3 Hallux Valgus & Bunions Bunio – to enlarge Common Unclear cause Female predominant Barefoot protection Degenerative Acquired Familial Hypermobile 1 st MTC Metatarsus Primus Varus Hyperpronated 1 st Ray Medial slanted 1 st MTC

4 Choo – Blahniks Disease!

5 Footwear

6 Pathology Lateral deviation of hallux Medial bunion Metatarsus primus varus Sesamoid subluxation Pronation of the hallux

7 Signs and Symptoms Asymptomatic Pain Tenderness Infection Aesthetic ‘It might get worse’

8 Signs

9 Radiologically

10

11 Move Over Jimmy Choo

12 Differentials

13 Non Operative Measures

14 Surgery Wilsons McBride Modified McBride Kellers Chevron Silver SCARF Akin Basal Opening Wedge BRT Arthrodesis

15 Post Operative Stable osteotomy Heel weight bear Flexible correction Light dressing Back to work

16 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 1 st Metatarsal

17 Hammer Toe

18 Normal Toe Positioning

19 In Shoes!

20 Hammer Toe

21 Incidence Incidence 2-20% population Female : male= 4:1 Mallet:Hammer = 1:9 Increase at years old

22 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

23 Long Toes - Mallet/Hammer

24 Treatment - Hammer Flexible Rigid MTP hyperextension FDL tight Associated H/Valgus

25 Treatment - Hammer

26 Treatment - surgical DuVries arthroplasty - rigid F.E.T.T - flexible Partial phalangectomy & syndactylisation Amputation Silicon arthroplasty

27 DuVries Arthroplasty

28

29 Post Operative Care Compression bandage Mobilise in cast R/O wire 3/52 Support toe further 4/52

30 Treatment - Dynamic Hammer Flexible/Dynamic deformity FDL contracture Only present on standing Treat by FDL tendon transfer

31 Flexor to Extensor Tendon Transfer

32

33

34 Results High Fusion - bony/fibrous 50-80% satisfactory Excellent pain relief 54% correction of MTP subluxation

35 Complications Swelling Transient numbness PIP joint stiffness Residual angulation Continuing pain Pin tract infection MTP hyperextension Moulding

36 Claw Toes

37 Claw Toes - causes Unclear Associated with muscle imbalance RA Collagen deficiency syndromes Cavus foot Idiopathic

38 Muscle Action - at rest

39 Muscle Action - EDL

40 Muscle Action - FDL

41 Muscle Action - EDL/FDL

42 Clinical Examination Neurological Vascular Flexible/ Rigid Callosity Nail problems Space locally

43 Radiological Assessment Bony deformity seen Subluxation or dislocation Gun Barrel Sign

44 Claw Toes

45 Treatment - Claw Toes Depends on pathology, i.e. cavus Conservative Surgical Again flexible/rigid Treat both Hammer and MTP joint components

46 Treatment - Claw Toe

47 Results & Complications - Claw 70-90% Fair/good post operation Recurrence of deformity a problem Persistent metatarsalgia

48 Mortons/Interdigital Neuroma Difficult to diagnose Pain into toes Aggrevated by activity Tingling in toes Non descript burning Metatarsalgia Stress # MT bursae

49 Morton’s 45% 25%

50 Mulders Click

51 Ultrasound in Mortons

52 Diagnosis & Treatment Clinical USS LA injection MRI Wide fitting shoes Many settle Steroid Excision Neurolysis Intermetatarsal release

53 Outcomes Dependant on diagnosis 80% satisfaction

54


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