Digital Deformities Flashcards
FLEXOR STABILIZATION
Most common mechanism ~80%
*Occurs in a pronated foot in stance
*FDL and FDB overpower the interossei
*Increased pull of long flexors which gain mechanical advantage
*Flexors fire earlier and longer to help stabilize pronated, hypermobile foot
*Intrinsics can not counter the deforming force
EXTENSOR SUBSTITUTION
Swing phase condition due to weak anterior leg muscles
*Secondary to ankle equinus, weak lumbricals, spastic EDL, anterior cavus
*Extensor muscles gain mechanical advantage over the lumbrical muscles
FLEXOR SUBSTITUTION
Occurs when the deep posterior and lateral muscle groups
overcompensate for a weak triceps surae
*A supinated high arch foot with contracture of the digits results from
the early and prolonged contracture of the FDL, FHL, tibialis posterior,
and peroneus longus muscles.
DIGITAL DEFORMITIES
bnormal contraction of
lesser digits
*They can be flexible, semi-rigid, or rigid in nature
HAMMERTOE
Deformity occurs in the sagittal plane
*Proximal phalanx is DF, middle phalanx is PF.
*MPJ may be prominent plantarly
MALLET TOE
Sagittal plane deformity in which the distal phalanx is flexed on the
middle phalanx
*Often associated with a long digit
CLAW TOE
Deformity where the middle and distal phalanges are
flexed on a dorsiflexed proximal phalanx
*MPJ is prominent plantarly
*Often associated with cavus foot deformity or a
neuromuscular disorder
SYMPTOMS: digital deformities
Pain or irritation of the affected toe when wearing shoes
*Corns and calluses on the dorsum of the toe, between the toes, or on the
plantar forefoot secondary to retrograde pressure on the metatarsal head
*Inflammation, redness, or a burning sensation of the digit
*Contracture of the digit
also ulcerations
CONSERVATIVE TREATMENT
Wider and deeper toe box
*Padding/offloading
*Orthoses
SURGICAL TREATMENT
Exostectomy
*Phalangectomy
*Arthroplasty
*Arthrodesis
*Tendon Transfer
*Capsulotendon Balancing
*MPJ Release
*Weil
*Amputation
FIRST METATARSOCUNEIFORM EXOSTOSIS
Excessive motion of 1st met during
propulsive period of gait
*Hypermobile 1st ray
*Trauma
SESAMOIDITIS
pain and inflammation sub met 1
*Edematous
*Bipartite versus Fracture
*Contralateral X-rays may help
METATARSUS PRIMUS EQUINUS
Excess plantarflexion of 1st Ray
*Can be structural or positional
*Structural (congenital plantarflexion associated with
cavus foot)
*Positional (compensation for supinated foot)
MANAGEMENT: first ray deformities
Orthoses
*Padding/offloading
*Surgical intervention
*Dorsiflex the 1st ray
METATARSUS PRIMUS ELEVATUS
1st metatarsal is dorsally deviated in the sagittal plane relative to lesser
metatarsals
*Results in Hallux Limitus/Rigidus
*Assess through manual ROM and radiographs (lateral view).
Long or short metatarsal
*Short proximal phalanx
*Hypermobile medial column
*Degenerative arthritis
*Iatrogenic
MANAGEMENT: met primus elevatus
Orthoses
*Padding
*Surgical Intervention
*Plantarflex the metatarsal
HALLUX LIMITUS
Restriction of 1st MPJ
*Less than 65 degrees
*Leads to hallux rigidus
*Sesamoidal hypertrophy
*May see hallux extensus develop
Hypermobility of 1st ray
*Propulsive phase pronation
*Metatarsus primus elevatus – structural elevation of 1st met
*Congenital, Post-traumatic, Structural
*Iatrogenic – inadvertent DF with CBWO, patient walking s/p 1st ray surgery leading to
failure of fixation
HALLUX LIMITUS
Structural
*Intrinsic problem with 1st ray, fixed/rigid position, non-reducible
*Functional
*Secondary to hypermobility, seen only weightbearing/with gait,
reversible/reducible by controlling hyperpronation
RADIOGRAPHICALLY: Hallux Limitus
Lateral view XR
*Distal first met will be sitting higher than second
*Seiberg’s index, dorsal exostoses, Flag sign, narrowing of joint space
*Stress lateral hallux DF XR
*Patient raises heel off ground
*First ray is not parallel to 2nd with elevation distally, won’t rotate
up on sesamoid complex/sits behind it
HALLUX ABDUCTO VALGUS
Overlying enlargement of first met head
*Sesamoids track laterally
*1st met adducts
*Hallux abducts
ETIOLOGY
Developmental
*Shoegear
*Hypermobility at the medial column
*Fully Compensated RF Varus
*RF Valgus
*Fully Compensated FF Varus
CLINICAL EVALUATION
Prominent dorsomedial eminence
*Quality of ROM
*Tracking vs. Trackbound
*EHL tendon
*Pain on palpation
*Other associated deformities
HALLUX VARUS
Congenital
*Excessive tightness of medial soft tissue structures
*Metatarsus adductus
*Iatrogenic – Most Common!
MANAGEMENT: hallux varus
Surgical
*Depends on length of deformity
*Immediate post op HAV complication –
reverse your procedure
*Long term – Fusion or joint destructive
procedure
