Armen S. Kelikian

1. Mallet toe: flexion deformity at the distal interpha-langeal (DIP) joint

2. Hammer toe: flexion deformity at the proximal interphalangeal (PIP) joint and mild extension at the metatarsophalangeal? (MTP) and DIP joints

3. Claw toe: flexion deformity at the PIP joint and hyperextension at the MTP joint

4. Deviated toe: MTP joint in either varus or valgus

5. Crossover toe: medial deviation of the second toe crossing over the first toe with an associated hammer toe deformity

6. Curly toe: the fourth or fifth toes may appear curved, but they are not angulated

1. Fixed deformity

2. Nonresponsive to conservative measures such as wide toe box shoes and pads, toe crescents

1. Peripheral vascular disease

2. Narcissism

1. Physical examination

a. Cock-up test (hyperextension at the MTP joint with plantar pressure)

b. Lachman test (instability of the second MTP joint)

c. Assess position of the hallux and first ray.

d. Examine the foot for associated hard corns, keratoses, and soft corns (clavus).

1. Patient positioned supine on standard operating room table

2. This procedure can de done under local anesthesia.

3. An ankle tourniquet (at 250 mm) is optional.

4. #15 blade

5. Freer elevator

6. Meyerding retractors

7. Double skin hooks

8. Microsagittal saw blade

9. 0.045-, 0.054-, 0.062-in smooth K-wire

10. 3-0 Vicryl sutures

11. 5-0 Nylon sutures

1. A pulse oximeter placed on the toe is an excellent method of checking oxygen delivery to the foot.

1. If toe circulation is compromised after K-wire instrumentation, it should be removed.

1. Apply a standard well-padded foot dressing.

2. Remove the K-wires at 3 weeks for PIP joint and DIP arthroplasty, and at 4 weeks when the MTP joint has been crossed.

3. Ambulation should be in stiff-soled postoperative shoes.

4. When the pins are removed, tape the adjacent digits together.

Approach

1. Prepare and drape the foot in the hospital’s standard sterile fashion ensuring adequate exposure available.

2. If a tourniquet is to be utilized, the foot should be exsanguinated and the ankle tourniquet inflated.

Procedure

a. Flexible mallet toes