How To Handle Complications Of Hammertoe Surgery

By Lowell Weil Jr., DPM, MBA, and Richard A. Schilling, DPM

     The most common positional complication is positioning the toe in too straight an alignment. A toe that is too straight can cause many problems. It may not fit in proper alignment with the other toes of the foot and become irritated. It may also lead to a mallet toe deformity or even a reverse or swan neck deformity. The most common cause of this positional complication is placing K-wires with the toe hyperextended.

     Using the Steristrip splintage provides superior results in maintaining a correct alignment without the fear of over-straightening the toe. Steristrips allow one to put the toes in physiological flexion while still maintaining excellent stability. Utilizing Steristrips instead of K-wires also allows patients to return to bathing and closed shoes at one week after surgery.

Addressing Nonunions And Other Complications Involving K-Wires

     Nonunions can be quite common when it comes to performing an arthrodesis procedure. Since these nonunions are usually not symptomatic and function as a pseudoarthrosis, they rarely need revision. Inadequate bone resection or bone-to-bone apposition are common causes of nonunions. Additionally, K-wires can maintain a separated position of the fusion site, which can lead to the nonunion. When revision is necessary, resecting the nonunion to an arthroplasty with or without an implant can be a simple solution. Utilizing bone graft and additional fixation can become a hazardous and traumatic event for the frequently operated upon toe.

     One may see other complications that involve K-wires. Pin tract infections, K-wire migration and loss of fixation can all occur. Utilizing alternative forms of stability such as Steristrips or bandaging techniques may offer better solutions than K-wires. We have found that placing one or two 1/4-inch Steristrips longitudinally from the distal pulp of the toe and secured to beyond the metatarsophalangeal joint dorsal proximally allows for the same stability without the inherent complications associated with K-wire fixation.

Proactive Tips For Minimizing Post-Op Complications With Implants

     Hammertoe implants have received negative publicity over the last 20 years but they offer an excellent alternative to many surgical procedures for hammertoes. Hammertoe implants can offer a happy medium of increased stability over an arthroplasty without the stiff, immobile joint of an arthrodesis. Patient satisfaction rates are very high both in the literature and in our experience. While complications are not common with implants, they do occur. According to the literature, the most common complications were bony regrowth, prolonged edema, limited range of motion, poor toe purchase and implant removal.5

     In our experience, the most common complications with hammertoe implants are breakage of the implant with chronic pain and swelling of the toe. In regard to breaking of the implant, the causes are unknown and rare. However, they may be due to excessive angular force or trauma on the toe and implant. When an implant breaks, removing or replacing it is a predictable solution. While implant engulfment is a very rare complication, it can lead to pain in the joint. Removing and/or replacing the implant may also be necessary in that situation.

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.

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