How To Address Complications Of Hammertoe Surgery

By Molly Judge, DPM

Residual MPJ subluxation. Neuritis. Flail toe. Hypertrophic scars. These are just some of the complications that can occur with hammertor surgery. Accordingly, this author offers proactive pointers for reducing the risk of complications and facilitation optimal outcomes. A host of potential complications may result from hammertoe surgery and the most common list includes but is not limited to: infection, neuritis, painful or unsightly scarring, chronic swelling, malunion or nonunion of bone, and recurrence of deformity. While these untoward results can occur, they are unlikely if both the surgeon and the patient follow the basic principles of surgery and postoperative care. Other complications of hammertoe surgery are possible and many of these are the result of technical failures in performing the procedure.    Complications in hammertoe surgery often have more to do with a failure to recognize the biomechanical influences that caused the deformity than an actual failure in performing the procedure. This can occur when one fails to identify the apex of the digital deformity accurately. For example, correction of a sagittal plane deformity at the proximal interphalangeal joint will fail if the surgeon does not address the ill effects of a taut extensor digitorum longus tendon and extensor hood apparatus, a long metatarsal bone, metatarsophalangeal joint (MPJ) subluxation or the subtle combination of both that often complicate a hammertoe deformity.    An obvious but often overlooked error in procedure selection is the tendency to perform “chief complaint” surgery without identifying and eliminating associated functional or structural insufficiency of the first ray segment. The natural history of first ray insufficiency and hallux abductovalgus deformity includes forefoot imbalance and an overloading of the lesser rays as a consequence. For example, the outward signs of a subtle metatarsus primus elevatus are easy to overlook and this can lead to an imbalance that exacerbates a hammertoe deformity.

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