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M Doblare - One of the best experts on this subject based on the ideXlab platform.
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stress at the second metatarsal bone after correction of hammerToe and Claw Toe deformity a finite element analysis using an anatomical model
Journal of the American Podiatric Medical Association, 2013Co-Authors: Javier Bayod, Ricardo Becerro De Bengoa Vallejo, Marta Elena Losa Iglesias, M DoblareAbstract:Background: We used finite element analysis to evaluate three techniques for the correction of hammerToe and Claw Toe deformities: flexor digitorum longus tendon transfer (FDLT), flexor digitorum brevis tendon transfer (FDBT), and proximal interphalangeal joint arthrodesis (PIPJA). Methods: We performed a finite element analysis of FDLT and FDBT compared with PIPJA of the second Toe using multislice computed tomography and 93 tomographic images of the foot obtained in a healthy 36-year-old man. Results: The PIPJA showed a significantly higher increase in traction and compressive stresses and strain at the medial aspect of the shaft of the second metatarsal bone compared with FDLT or FDBT (P < .01). Mean ± SD compressive stresses increased to −4.35 ± 7.05 MPa compared with the nonsurgical foot (−3.10 ± 4.90 MPa). It can, therefore, be hypothesized that if PIPJA is used to correct the hammerToe and Claw Toe deformities, it could also increase traction and compressive stresses and strain in the metatarsals d...
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advantages and drawbacks of proximal interphalangeal joint fusion versus flexor tendon transfer in the correction of hammer and Claw Toe deformity a finite element study
Journal of Biomechanical Engineering-transactions of The Asme, 2010Co-Authors: Javier Bayod, Juan Carlos Pradosfrutos, Marta Elena Losaiglesias, Kevin T Jules, Ricardo Becerro De Bengoavallejo, M DoblareAbstract:Correction of Claw or hammer Toe deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical Toe.
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finite element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of Claw Toe deformity
Journal of Biomechanics, 2009Co-Authors: Alberto Garciagonzalez, Javier Bayod, M Doblare, Juan Carlos Pradosfrutos, Marta Elena Losaiglesias, Kevin T Jules, Ricardo Becerro De BengoavallejoAbstract:Claw Toe deformity sometimes leads to dorsiflexion of the metatarsophalangeal joint (MPJ) and plantar flexion of the proximal (PIPJ) and distal interphalangeal (DIPJ) joints. Flexor digitorum longus tendon transfer (FDL) is currently the gold standard for the correction of this problem. Transfer of the flexor digitorum brevis (FDB) has been recently proposed as an alternative method to treat such deformity. The aim of this work is to compare the biomechanical outcome of these two methods by means of finite-element simulation. The results show that the reduction in the dorsal displacement of the proximal phalanx (PP) for the second and third Toes were very similar (about 4.3 mm for each intervention), both achieving a significant reduction in MPJ dorsiflexion when compared to no intervention (displacements are reduced by approximately 51%). In the fourth and fifth Toes, only a small correction in the deformity was achieved with both the techniques (10% and 7%, respectively). FDB and FDL tendon transfer reduced the stress level when compared with the non-operated pathologic foot (the reduction of stresses for the second and third PP ranged between 20% and 40%). FDB transfer resulted in a more uniform distribution of stress along the entire Toe, although differences were small in all cases. These results confirm that both the tendon-transfer techniques are effective in the treatment of Claw Toe deformity. Therefore, the choice of technique is at the discretion of the surgeon.
H. Ahmed - One of the best experts on this subject based on the ideXlab platform.
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The two-pin arthrodesis technique for proximal interphalangeal joint fusion of the lesser Toes
European Journal of Orthopaedic Surgery & Traumatology, 2010Co-Authors: V Naidu, I. Gill, P. Lakkireddi, H. AhmedAbstract:Arthrodesis of the proximal interphalangeal (PIP) joints of the lesser Toes is a commonly performed procedure for correction of the Claw Toe and hammer Toe deformity. Multiple techniques of fixation have been described to achieve a solid fusion with variable fusion rates (Coughlin and Polk in Operative repair of the fixed hammerToe deformity. Foot Ankle Int 21(2):94–104, 2000 ). The standard technique for many years uses a single intramedullary K-wire (Baig and Geary in Fusion rate and patient satisfaction in proximal interphalangeal joint fusion of the minor Toes using Kirschner wire fixation. The Foot 6:120–121, 1996 ). We present our technique of fusing the PIP joint with two fine K-wires, used to prevent rotational displacement and ensure sound arthrodesis. Our series of 36 fusions in 25 patients were assessed independently using the American College of foot and ankle surgeons score (ACFAS) and the Foot Function Scale (FFS). A fusion rate of 97% was achieved with 89% of patients were satisfied with the appearance of their Toes. There was a significant reduction in pain levels with 90% of patients reporting no pain with normal activities. We believe our simple improvement to the single wire technique results in superior outcomes.
Jan Willem K Louwerens - One of the best experts on this subject based on the ideXlab platform.
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treatment of metatarsalgia based on Claw Toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint evaluation based on foot kinematics and plantar pressure distribution
Foot and Ankle Surgery, 2019Co-Authors: Niki M Stolwijk, Noel L W Keijsers, Jantsje H Pasma, Wandana Nanhoemahabier, Jacques Duysens, Jan Willem K LouwerensAbstract:Abstract Introduction This study investigated the effect of operative Claw Toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). Methods Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic Claw Toes were measured three months before and 12 months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N = 15). Results Claw Toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and Toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. Discussion These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on Claw Toe deformity.
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definitions of hammer Toe and Claw Toe an evaluation of the literature
Journal of the American Podiatric Medical Association, 2009Co-Authors: Joost C M Schrier, Cees C P M Verheyen, Jan Willem K LouwerensAbstract:BACKGROUND: Lesser Toe surgery is among the most conducted interventions in general orthopedic practice. However, the definitions of hammer Toe and Claw Toe are not uniform. The objective of this literature study is to propose clear definitions for these deformities to establish unambiguous communication. METHODS: A literature search was performed in the PubMed database (May 2006). Of 81 eligible articles, 42 that stated a clear definition of hammer Toe or Claw Toe were selected. RESULTS: In all 35 articles in which hammer Toe was clearly defined, flexion in the proximal interphalangeal joint was part of the definition. Seventeen articles (49%) defined hammer Toe as a combination of metatarsophalangeal extension and proximal interphalangeal flexion. Thirteen articles showed flexion of the proximal interphalangeal joint as the single criterion. Twenty-three articles with a clear definition of Claw Toe were selected. Twenty-one articles (91%) showed metatarsophalangeal extension as part of the Claw Toe deformity. Twelve articles (52%) regarded metatarsophalangeal extension and flexion of the proximal interphalangeal and distal interphalangeal joints as the essential characteristics. Seven articles described a Claw Toe as metatarsophalangeal extension with flexion in the proximal interphalangeal joint. CONCLUSIONS: There are variations in the definitions of lesser Toe deformities in the literature. We propose that extension of the metatarsophalangeal joint is the discriminating factor and essential characteristic for Claw Toe. Claw Toe and hammer Toe should be characterized by flexion in the proximal interphalangeal joint, which is the single criterion for a hammer Toe. The flexibility of these joints could be a basic factor in discriminating between these deformities. The development of these deformities should be regarded as a continuum in the same pathophysiologic process.
M F Gargan - One of the best experts on this subject based on the ideXlab platform.
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Curly Toe, hammer Toe, Claw Toe and mallet Toe: are they good descriptive terms of the associated deformities of the lesser Toes?
European Journal of Orthopaedic Surgery & Traumatology, 2005Co-Authors: M J Barakat, R Buckingham, M F GarganAbstract:L’orteil enroulé, l’orteil en marteau, l’orteil en griffe et l’orteil en maillet sont toutes les dénominations qui décrivent des défauts de forme spécifiques des petits orteils. Plusieurs définitions ont été employées pour décrire chacun des défauts de forme (Boc and Martone in J Food Ankle Surg 34(2):220–222, 1995; Bignel in Lancet 342(8865):235, 1993; Mizel and Yodlowski in J Am Acad Orthop Surg 3(3):166–173, 1995; Coughlin in Instr Course Lect in Instr Course Lect 52:421–444, 2003; Coughlin in Foot Ankle Int 16(3):109–116, 1995). Nous visons à quantifier les variations de ces dénominations et à déterminer si les défauts de forme seraient mieux décrits en utilisant les noms de leur position. Des questionnaires ont été distribués de la main à la main à 24 consultants et à 33 séniors dans 5 grands hôpitaux universitaires. Les participants ont été invités à tracer un diagramme schématique de chacun des défauts de forme. 90% des consultants et 85 % des séniors ont renvoyé les questionnaires. Il y avait une variation de 17% (Kappa=0.66) des réponses des consultants pour l’orteil enroulé par rapport à une variation de 30% des réponses des séniors (Kappa = 0.4). Il y avait également une variation de 12% (Kappa=0.76) des réponses des consultants pour l’orteil en marteau par rapport à une variation de réponse des séniors de 24% (Kappa=0.52). Il y avait une variation de 8% (Kappa=0.84) des réponses des consultants pour l’orteil en griffe, avec une variation de réponse des séniors de 18% (Kappa=0.64). Quant à l’orteil en maillet, il n’y avait aucune variation des réponses des consultants (Kappa=1), mais il y avait une variation de réponse des séniors de 8% (Kappa=0.82). Il y avait variation marquée de la description de ces dénominations parmi les consultants et plus encore parmi les séniors où plusieurs points de kappa où au-dessous du niveau acceptable de la variation de 0.8 (Carletta in Comput linguistics 22(2):1–6, 1996). Nous préconisons donc l’utilisation de la terminologie objective orthopédique de décrire les défauts de forme des petits orteils. Curly Toe, hammer Toe, Claw Toe and mallet Toe are all terms that describe specific deformities of the lesser Toes (Boc and Martone in J Food Ankle Surg 34(2):220–222, 1995; Bignel in Lancet 342(8865):235, 1993; Mizel and Yodlowski in J Am Acad Orthop Surg 3(3):166–173, 1995; Coughlin in Instr Course Lect in Instr Course Lect 52:421–444, 2003; Coughlin in Foot Ankle Int 16(3):109–116, 1995). Several definitions have been used to describe each one of the deformities. We aim to quantify any variation of understanding of these terms and determine whether the deformities would be better described in terms of their position. Questionnaires were circulated by hand among 24 orthopaedic consultants and 33 registrars in 5 major teaching hospitals. The participants were asked to draw a schematic diagram of each of the deformities. There was a 90% consultant and 85% registrar return of forms. There was a 17% variation (Kappa=0.66) in consultant replies to curly Toe as compared to a 30% variation in registrar replies (Kappa=0.4). There was also a 12% variation (Kappa=0.76) in consultant replies to hammer Toe as compared to a registrar reply variation of 24% (Kappa=0.52). There was an 8% variation (Kappa=0.84) in consultant replies to Claw Toe, with a registrar variation of 18% (Kappa=0.64). With regards to mallet Toe, there was no consultant variation (Kappa=1), but there was a registrar variation of 8% (Kappa=0.82). There was marked variation in the description of these terms among consultants and more so among registrars where several kappa scores where below the acceptable level of variation of 0.8 (Carletta in Comput linguistics 22(2):1–6, 1996). We therefore advocate the use of orthopaedic objective terminology to describe these deformities of the lesser Toes.
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curly Toe hammer Toe Claw Toe and mallet Toe are they good descriptive terms of the associated deformities of the lesser Toes
European Journal of Orthopaedic Surgery and Traumatology, 2005Co-Authors: M J Barakat, R Buckingham, M F GarganAbstract:Curly Toe, hammer Toe, Claw Toe and mallet Toe are all terms that describe specific deformities of the lesser Toes (Boc and Martone in J Food Ankle Surg 34(2):220–222, 1995; Bignel in Lancet 342(8865):235, 1993; Mizel and Yodlowski in J Am Acad Orthop Surg 3(3):166–173, 1995; Coughlin in Instr Course Lect in Instr Course Lect 52:421–444, 2003; Coughlin in Foot Ankle Int 16(3):109–116, 1995). Several definitions have been used to describe each one of the deformities. We aim to quantify any variation of understanding of these terms and determine whether the deformities would be better described in terms of their position. Questionnaires were circulated by hand among 24 orthopaedic consultants and 33 registrars in 5 major teaching hospitals. The participants were asked to draw a schematic diagram of each of the deformities. There was a 90% consultant and 85% registrar return of forms. There was a 17% variation (Kappa=0.66) in consultant replies to curly Toe as compared to a 30% variation in registrar replies (Kappa=0.4). There was also a 12% variation (Kappa=0.76) in consultant replies to hammer Toe as compared to a registrar reply variation of 24% (Kappa=0.52). There was an 8% variation (Kappa=0.84) in consultant replies to Claw Toe, with a registrar variation of 18% (Kappa=0.64). With regards to mallet Toe, there was no consultant variation (Kappa=1), but there was a registrar variation of 8% (Kappa=0.82). There was marked variation in the description of these terms among consultants and more so among registrars where several kappa scores where below the acceptable level of variation of 0.8 (Carletta in Comput linguistics 22(2):1–6, 1996). We therefore advocate the use of orthopaedic objective terminology to describe these deformities of the lesser Toes.
V Naidu - One of the best experts on this subject based on the ideXlab platform.
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NEW TECHNIQUE TO TREAT SEVERE CROSSOVER Toe DEFORMITY
2018Co-Authors: V Naidu, T Holme, S Mahir, S ParabaranAbstract:Introduction Crossover and Claw Toe deformity has traditionally been a very difficult condition to manage surgically, with high recurrence rates. Multiple methods have been used to treat this condi...
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The two-pin arthrodesis technique for proximal interphalangeal joint fusion of the lesser Toes
European Journal of Orthopaedic Surgery & Traumatology, 2010Co-Authors: V Naidu, I. Gill, P. Lakkireddi, H. AhmedAbstract:Arthrodesis of the proximal interphalangeal (PIP) joints of the lesser Toes is a commonly performed procedure for correction of the Claw Toe and hammer Toe deformity. Multiple techniques of fixation have been described to achieve a solid fusion with variable fusion rates (Coughlin and Polk in Operative repair of the fixed hammerToe deformity. Foot Ankle Int 21(2):94–104, 2000 ). The standard technique for many years uses a single intramedullary K-wire (Baig and Geary in Fusion rate and patient satisfaction in proximal interphalangeal joint fusion of the minor Toes using Kirschner wire fixation. The Foot 6:120–121, 1996 ). We present our technique of fusing the PIP joint with two fine K-wires, used to prevent rotational displacement and ensure sound arthrodesis. Our series of 36 fusions in 25 patients were assessed independently using the American College of foot and ankle surgeons score (ACFAS) and the Foot Function Scale (FFS). A fusion rate of 97% was achieved with 89% of patients were satisfied with the appearance of their Toes. There was a significant reduction in pain levels with 90% of patients reporting no pain with normal activities. We believe our simple improvement to the single wire technique results in superior outcomes.