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Gregory J. Kramer, DPM, FACFAS Ankle and Foot Associates of Southern Georgia.

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Presentation on theme: "Gregory J. Kramer, DPM, FACFAS Ankle and Foot Associates of Southern Georgia."— Presentation transcript:

1 Gregory J. Kramer, DPM, FACFAS Ankle and Foot Associates of Southern Georgia

2 Anatomy Classification Etiology Treatment Surgical Arthroplasty vs. Arthrodesis OrthoPro Screw 2

3 Osseous Structures Soft Tissue Structures 3

4 Metatarsal Head Shaft Base Phalanges Proximal Middle Distal Head Shaft Base Articulations Metatarsal Phalangeal Joint (MPJ) Proximal Interphalangeal Joint (PIPJ) Distal Interphalangeal Joint (DIPJ) 4

5  Tendons  Extrinsic Extensor digitorum longus Flexor digitorum longus  Intrinsic Extensor digitorum brevis Flexor digitorum brevis Dorsal and Plantar Interossei Lumbricles Quadratus plantae 5

6 Classic Hammertoe Claw Toe Mallet Toe Rigid Flexible 6

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11 Genetic Acquired Shoe gear Trauma Biomechanical Flexor Stabilization Flexor Substitution Extensor Substitution 11

12 Conservative Surgical 12

13 Shoe modification Accommodative padding Orthotic devices 13

14 “You have this” “We are going to give you this” “Is it really that simple?” 14

15 Soft Tissue Procedures Osseous Procedures Sequential Release 15

16 Tenotomy Extensor tenotomy and capsulotomy Flexor tenotomy and capsulotomy Flexor tendon transfer 16

17 Resection of base of proximal phalanx Syndactylization Arthroplasty Arthrodesis 17

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19 Most common procedure performed for hammertoe correction May or may not require fixation Usually requires addition of soft tissue procedures 19

20 Types of fixation K-wire Absorbable rod Implants Shaw rod Ship implant 20

21 Usually requires addition of soft tissue procedures Is not performed on the fifth digit Requires fixation Types of fixation K-wires (smooth or threaded) Screws Various implants 21

22 End to End Peg in hole Insitu 22

23 Arthroplasty Most common procedure performed for hammertoe correction Technically easy procedure Some motion is retained Shortening of digit is inherent to procedure May be unstable Increased chance of recurrence of hammertoe deformity Fixation K-wire Implant Indications Flexible to semi – rigid deformity Not as common Technically more difficult procedure No motion, toe is rigid Maintains relative length of digit Stable Minimal chance of recurrence Longevity of correction Fixation Screw Threaded or Smooth K-wire Implant Indications: Loss of Intrinsic muscle stability  Diabetes  Neuromuscular conditions Athrodesis 23

24 Technically easy No exposed K-wire Less chance of pin tract infection No need to remove the pin at a later date Less chance of bending or breaking of the pin Quicker return to bathing and shoe gear Provides superior compression Provides stability even in the face of pseudoarthrosis Stabilizes both distal and proximal interphalangeal joints 24

25 Don’t try to be an expert on procedure choice Be the expert on your implant Know the technical aspects of your implant (i.e. lengths, diameter, etc.) 25


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