Toe deformities

Question 1

What is congential hallux varus?

Answer 1

• An adduction deformity of the great toe characterised by
  
  • deformity at MTPJ
  • short thick 1st MT
  • firm like band adductor hallucis muscle

Question 2

Name associated conditions of congential hallux varus?

Answer 2

• Polydactyly

Question 3

What is the tx of congential hallux varus?

Answer 3

Non operative

• Observation alone
• most cases

Surgery

• Adductor hallucis muscle release
• rare cases

Question 4

What is syndactyly of toes?

Answer 4

• Fusion of foot digits
• Simple = just soft tissue
• Complex= if bony fusion

Question 5

What is the tx of syndactyly?

Answer 5

• Simple = doesn’t require tx
• complex= operative like the hand

Question 6

What is this?

Answer 6

• polydactyly
• extra digits of the toes
• usually involve lateral ray
• Transmitted Autosomal Dominant - +ve FHx
• May involve extra phalanges or even duplication of rays

Question 7

What is the tx of polydactyly?

Answer 7

• Operative
  
  • Ablation of extra digit ( usually border)
  • peform at 9-12 months old
  • small skin tags can be removed in newborn nursery

Question 8

What is this?

Answer 8

• Oligodactylyl
• Congential absence of toes

Question 9

What is oligodactyly associated with?

Answer 9

• Fibular Hemimelia
• tarsal coalition

Question 10

What is the tx of Oligodactyly?

Answer 10

• Non operative
• no tx required

Question 11

What is this?

Answer 11

• Congential deformity characterised by a 5th toe that overlaps 4th
  
  • ​Overlapping toe
• Usually bilateral
• may cause problems with shoewear

Question 12

What is the tx of overlapping 5th toe?

Answer 12

Non operative

• Initial tx is passive strecthing and buddy taping

Operative

• Tenotomy
• Dorsal capsulotomy
• Syndactylization the 4th toe- McFarland procedure

Question 13

What is this?

Answer 13

• Congential curly toes
• common congential deformity
  
  • flexion and varus deformity of the interphalangeal joints
• ​Usually involves Lateral 3 toes
• Usually Bilateral

Question 14

What is the common cause of congential curly toes?

Answer 14

• contracture of the flexor digitorium longus (FDL) or flexor digitorium brevis (FDB)

Question 15

What is the symptoms of congential curly toes?

Answer 15

• Asymptomatic

Question 16

What is the tx of congential curly toes?

Answer 16

• Non operative
  
  • Observation
    
    • usually asymptomatic requires no tx
    • toe strapping not beneficial
• Operative
  
  • Surgical soft tissue release
    
    • FDL release reserved for severe toe deformity, pain, difficulty with shoe wear or nail bed deformity in children typically > 3 years old
    • outcomes 85-90% effective

Question 17

Describe the technique for surgical soft tissue release of FDL in congential curly toes?

Answer 17

• Open tenotomy of both slips of Flexor digitorium brevis (FDB) and FDL tendon
• Open tenotomy of one slip of flexor digitorium brevis ( FDB) only
• Flexor digitorium longus (FDL) transfer to extensor hood

Question 18

What is this?

Answer 18

• Brachymetatarsia
• Congential hypoplasia of one or more metatarsals
• Shortening of 4th MT- most common
• Often Bilateral

Question 19

What is the tx of brachymetatarsia?

Answer 19

Non operative

• Shoe modification
  
  • extra depth, extra wide shoes will generally improve symptoms
  • taping and manipulation= ineffective

Operative

• Metatarsal lengthening or amputation maybe indicated
  
  • if symptoms presist
  • extensor tenotomy and capsulotomy are not likely to sufficiently correct the deformity
  • fusion/metatarsal lengthening -> complications and not indicated

Question 20

What is this?

Answer 20

• Local Gigantism
• Macrodactyly
• may affect entire limb

Question 21

What is the epidemiology of Local Gigantism?

Answer 21

• Rare
• congential
  
  • Neurofibromatosis
  • Proteus syndrome
  • Kippel- Treuaunay - Weber
• Acquired
  
  • Amyloidosis
  • Elephantiasis ( Filariasis)
  • AV malformation
  • Tumour
  • Acromegaly

Question 22

What is are the symptoms and signs of local giantism?

Answer 22

• Symptoms
  
  • Pain
• Signs
  
  • enalarged digit/limb

Question 23

What is the tx of local giantism?

Answer 23

Non operative

• Observation
• monitor growth of affected region

Surgery

• Epiphysiodesis vs bony and soft tissue reduction proceedures
  
  • individualized based on aetiology, location of affected area, skeletal growth left and severity
• Amputation