1. HAMMERTOES CAUSES AND CORRECTIONS
Gregory J. Kramer, DPM, FACFAS
Ankle and Foot Associates
of Southern Georgia

2. Hammertoes Abnormal contracture of the joints of the lesser digits
Anatomy
Classification
Etiology
Treatment
Surgical
Arthroplasty vs. Arthrodesis
OrthoPro Screw 2

3. ANATOMY
Osseous Structures
Soft Tissue Structures 3

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

5. Soft Tissue Structures
Tendons
Extrinsic
Extensor digitorum longus
Flexor digitorum longus
Intrinsic
Extensor digitorum brevis
Flexor digitorum brevis
Dorsal and Plantar Interossei
Lumbricles
Quadratus plantae 5

6. Classifications
Classic Hammertoe
Claw Toe
Mallet Toe
Rigid
Flexible 6

7. Classic Hammertoe 7

8. Claw Toe 8

9. Mallet Toe 9

10. Push Up Test 10

11. Etiology of Hammertoes
Genetic
Acquired
Shoe gear
Trauma
Biomechanical
Flexor Stabilization
Flexor Substitution
Extensor Substitution 11

12. Treatment
Conservative
Surgical 12

13. Conservative Shoe modification Accommodative padding Orthotic devices13

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

15. Surgical Treatments Soft Tissue Procedures Osseous Procedures
Sequential Release 15

16. Soft Tissue Procedures
Tenotomy
Extensor tenotomy and capsulotomy
Flexor tenotomy and capsulotomy
Flexor tendon transfer 16

17. Osseous Procedures Resection of base of proximal phalanx
Syndactylization
Arthroplasty
Arthrodesis 17

18. Sequential Release 18

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

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

21. Arthrodesis 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. Types of Arthrodesis
End to End
Peg in hole
Insitu 22

23. ARTHROPLASTY VS. ARTHRODESIS
Athrodesis
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 23

24. ADVANTAGE OF ORTHOPRO SCREWS OVER K-WIRES OR IMPLANTS FOR USE IN DIGITAL ARTHRODESIS
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. Quips and Tips 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