How To Handle Complications Of Hammertoe Surgery

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How To Handle Complications Of  Hammertoe  Surgery
How To Handle Complications Of  Hammertoe  Surgery
How To Handle Complications Of  Hammertoe  Surgery
How To Handle Complications Of  Hammertoe  Surgery
How To Handle Complications Of  Hammertoe  Surgery
How To Handle Complications Of  Hammertoe  Surgery
Author(s): 
By Lowell Weil Jr., DPM, MBA, and Richard A. Schilling, DPM

What You Should Know About Other Complications

     Dorsal contracture can be a frustrating complication. It can occur when the surgeon has failed to address a more proximal etiology of the hammertoe such as metatarsophalangeal joint contracture. However, one may also see a dorsal contracture occur as a response to the body’s natural healing and scar contracture of a dorsally placed longitudinal incision.

     Employing a medial longitudinal approach can avoid this complication. However, surgeons can often use scar contracture to their advantage — especially when dealing with mallet toe deformities — by making a transverse elliptical incision across the distal interphalangeal joint. In cases of postoperative dorsal contracture recalcitrant to conservative care such as massage or physical therapy, we find it helpful to manipulate the joint under anesthesia to mobilize the joint.

     Floppy toes can result from excessive bony resection of a hammertoe. Patients often find this to be the most intolerable complication. They complain of discomfort, a feeling of uneasiness when putting on a sock and a feeling of insufficient function with ambulation. Employing more minimal resection intraoperatively, fusing the toe or utilizing an implant can prevent this complication. However, when floppy toes occur, it may be necessary to revise an existing implant, perform syndactylization or proceed with an amputation.

     Vascular compromise is the most severe complication one may see with hammertoe correction. Ensuring a proper preoperative assessment of vascular integrity is obviously the most important preventive measure. Excessive dissection can be an additional cause of vascular compromise. Excessive straightening of the toe maintained by K-wires is another common etiology of vascular problems. Changing the position of the wire intraoperatively or removing the K-wire early in the postoperative period when indications are present can help this problem. However, when a vascular compromise occurs, one should wait for demarcation to occur before pursuing definitive procedures.

In Conclusion

     Hammertoe repairs offer predictable, gratifying outcomes for the surgeon and patient. When performing these procedures, ensuring proper preoperative planning and intraoperative and postoperative management can reduce the incidence of complications. However, when complications arise, surgeons must address them in a proper and timely fashion.

Dr. Weil is the Fellowship Director of the Weil Foot and Ankle Institute in Des Plaines, Ill. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Schilling is a Fellow at the Weil Foot and Ankle Institute, and is an Associate of the American College of Foot and Ankle Surgeons.




References:


1. Harmonson, JK, Harkless, L: Operative procedures for the correction of hammertoe, claw toe, and mallet toe: a literature review. Clin Podiatr Med Surg. 1996 Apr;13(2):211-20.
2. ACFAS Preferred Practice Guidelines Committee: Hammer Toe Syndrome. J Foot Ankle Surg. 1999 Mar-Apr;38(2):166-78.
3. Caughlin, MJ et al: Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000 Feb;21(2):94-104.
4. Yu, GV, et al.: Techniques of digital arthrodesis: revisiting the old and discovering the new. Clin Podiatr Med Surg. 2004 Jan;21(1):17-50.
5. Sgarlatto, TE, Tafuri, SA: Digital Implant Arthroplasty. Clin Podiatr Med Surg. 1996 Apr;13(2):255-62




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