Case Study: Treating A Severe Fifth Digit Contracture Deformity

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Stephen L. Barrett, DPM, FACFAS, and Vincent P. Rascon, DPM, FACFAS

   We performed this via two 2-mm incisions; one on the dorsal lateral aspect of the fifth MPJ and one in the midline plantarly at the level of the proximal phalangeal base.

   It has been well established that employing soft tissue procedures in digital correction surgery rarely overcomes the osseous adaptation, which will remain present without adjuvant osseous correction. As one can see in the photos of the serial radiographs, the patient achieves complete osseous union even though there is a significant gap at the level of the osteotomy at the time of surgery, which is required for adequate correction.

   The final photos show that the cosmetic result is excellent. The patient is pain free and can wear any shoe.

   Dr. Barrett is an Adjunct Professor within the Arizona Podiatric Medicine Program at the Midwestern University College of Health Sciences. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Rascon practices in Midland, Texas


1. Wagreich CR. Congenital deformities. In: Banks AS, Downey MS, Martin DE, Miller SJ (eds): McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, 3rd Ed, Lippincott Williams & Wilkins, 2001. Chapter 42, pp. 1449-55.

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Michele Kurlanskisays: May 27, 2011 at 7:09 pm

Could this minimally invasive procedure be done as a revision for a failed arthroplasty, tendon lengthening and skin plasty of the 5th toe?

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Stephen Barrettsays: July 27, 2011 at 8:24 pm

Yes, because the use of a phalangeal base osteotomy would allow for more correction and also takes in the fact that once the joint surfaces have been congruent for so long in the deformed position, trying to realign the deformity at the joint level is usually impossible and not long lasting.

Even though this is minimally invasive surgery, there is a steep learning curve and there are many esoteric nuances that predicate either success or a less than desirable outcome.

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