Hammer toe syndrome Flashcards by Armi B

Deforming force

FDL

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Holding force

EDL

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deformity occurs at

PIPJ
DIPJ
Lumbricals

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two main ways to fix HDS

Arthroplasty

2. Arthrodesis

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Describe Arthroplasty?

Formation of movable joint by removing head of proximal phal to allow more space for movement

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can you do Arthroplasty at DIPJ?

Yes

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What is Arthrodesis?

bind up a joint-just take cartilage out so joint fuses

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Interossei are —- the DTML

above

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Lumbricals are —– the DTML

Below

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which muscles contract and shorten forcing the lumbricae into a right angle exacerbating the HDS?

Interossei muscles

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Define hammertoe

Hyperextension of the toe at the MPJ
Flexion at the PIPJ
Mild to severe Hyperextension at the DIPJ

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Hammertoe is primarily a ——plane deformity

Sagittal

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long 2nd toe can also cause

HDS

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define clawtoe

Hyperextension at MPJ
Flexion at PIPJ
Flexion at DIPJ

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clawtoe is primarily a ——plane deformity

Sagittal

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define Mallet toe

A flexion contracture at DIPJ

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Mallet toe is —–plane deformity

Sagittal

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How do you know if the Mallet toe is flexible?

push on the foot and see toe straighten out

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you see Gun Barrel sign in what kind of deformity?

Mallet toe

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define overlapping 5th toe

Dorsiflexion at the MPJ, with adduction and varus rotation of the 5th toe , the 5t toe may be riding on top of 4th toe

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Overlapping 5th toe is what kind of deformity?

Triplanar

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Digiti quinti varus is what kind of deformity?

Bi planar

Frontal and transverse

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how should your incision be for Digiti quinti varus?

perpendicular to the axis of rotation to de rotate the 5th toe

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What is Helloma Molle?

A soft corn usually in the 4th interspace , caused by the head of proximal phalanx of 5th toe rubbing againts the lateral condyle of the proximal phalanx of 4th toe

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What do you do about Helloma molle?

Do an arthroplasty of the head of the proximal phalanx of 5th toe (take it out) and then take out the little lateral condyle of the base of the proximal phalanx of 4th

What the best Antiobiotic for pseudo?

Cipro

What is the best Antiobiotic for staph?

Clinda

What is a congenital curly toe

A flexion and Varus rotation of the DISTAL PHALANX at the DIPJ. commonly involves the 3rd and 4th or 5th toes. caused by flexor stablization.

For flexor stabilization do arthroplasty for

older pts

For flexor stabilization do arthrodesis for

younger pts

High arch supinated foot causes

Extensor substiution (only do digital arthrodesis for this )

What are some etiologies for HDS?

-pathibiomechanics: pathological pronation and supination -Inflammatory arthritis - RH mostly -Shoegear -HAV: 2nd toe tries to stop big toe migration but cant so gets subluxed dorsally -congenital: dont do sx kids -trauma _ Neuromuscular: causes cavus or high arched feet, flexor and extensor substitution

What is the most common type of HDS etiology?

Flexor stablization

what is flexor stablization ?

when FDL and FDB overpowers interossei

FDL ----% of gait

10-51%

Interossei fire at ----% of gait

35-62%

When does flexor stablization occur in a pathologically pronated foot?

in the late stance phase of gait cycle

What are some roles of Quadratus plantae in flexor stablization?

- Stablize FDL tendon slips - stablizes Limbricales origins - Stablizes the oblique MT joint axis, lesser metatarsus W-stablizes toes against the lesser metatarsus

What direction pull of the QP on FDL digital slips is lost with pathologocal pronation and/or MTJ subluxation?

Posterior/lateral and may begins to pull posterior/ medial

what happens when angle and direction of pull is messed up?

propulsive instability of the most lateral (4th and 5th) toes. thus clinically see an adductovarus hammering of the 4th and 5th toes.

is it acceptable to do fusion/ arthrodesis on 5th toe?

NOOOO!! bc the shoe will rub on that stiff toe and cause irritation

What sx do you do on high arched foot?

Arthrodesis- bc there are so many deformities going on

What is flexor substitution?

Flexors overpowers interossei in conjuction with weak triceps surae.

What sx do you do for flexr stablization ?

Arthrodesis bc you are dealing with high arched feet

What are some etilogies for flexor substitution?

- TAL or gastroc recession | - supinated foot in late stance phase of gait

Weak triceps surae causes early and longer firing of what muscles?

TP FHL FDL which leads to digital deformities and STJ supination -> plantarflexes 1st ray with early and longer firing of the PL

Gastroc normally fires

10-52% of gait

soleus works about

5-42% of gait

What kind of gait do you see with Flexor stablization?

``` Calcaneous gait ( walkin on heels ) opposite of eqiuinus ```

if you have high arched foot you can only do

Arthrodesis | Don't do arthroplasty

Digital deformities do not occur in a completely non functional gastroc nc

the propulsive phase is absent

What is the least common cause of hammer toe?

flexor substitution

What is extensor substitution?

When EDL overpowers lumbricales

which phase of gait do you see more in extensor substitution?

More swing than stance

What Sx do you do in extensor substitution??

Arthrodesis-you want to straighthen the toe but also make them into rigid beams so they dont flop around

you do Arthrodesis in

High arched foot and extensor substitution

you ask pt dor Df the foot and you realize the toes are at 90 degrees to MT, this pt has

Extensor substitution

What muscle helps what muscles in terms ot making toes rigid beams and stablizing digits againt MT heads ?

EDL helping intrinsic muscles

extensor substitution etiology?

- Anterior pes cavus - FF equinus - lumbricales wasting - NM disease or PN - Spastic EDL - Ankle equinus - TA, EDL, EHL all trying to DF foot, so EDL causes overpowering of intrinsics and HDS

extensor substitution is created any time the

EDL gains biomechanical advantage over the lumbricales.

The EDL is a 2 phase muscle which gains advantage at either or both of thses times in gait

1. stablize the toes at propulsion | 2. Assists AJ dorsiflexion at early swing

During propulaive phase EDL functions to stabilize lesser toes by reinforcing

The rigid lever phenomenon initiated by the lumbricales

EDL stablized the PIPJ and DIPJ and creates with the lumbricales a

Rigid beam on the toe

lumbricales mm stablize the phalanges against

the ground reactive forces

rigid beams are created at

Early propulsion

What are the primary stablizers of the digits?

Lumbricales and interossei

which one is stronger? Lumbricales or EDL/EDB

lumbricales

At midstance lumbricales prevent

Hammering of the toe

What happens if lumbricales dysfunction at midstance ?

digital deformities