Toe deformities Flashcards
Congential hallux varus syndactylyl polydactyly Oligodactyly Overlapping toes Congential curly toe Brachymetatarsia Local Gigantism
What is congential hallux varus?
- An adduction deformity of the great toe characterised by
- deformity at MTPJ
- short thick 1st MT
- firm like band adductor hallucis muscle
Name associated conditions of congential hallux varus?
- Polydactyly
What is the tx of congential hallux varus?
Non operative
- Observation alone
- most cases
Surgery
- Adductor hallucis muscle release
- rare cases
What is syndactyly of toes?
- Fusion of foot digits
- Simple = just soft tissue
- Complex= if bony fusion
What is the tx of syndactyly?
- Simple = doesn’t require tx
- complex= operative like the hand
What is this?
- polydactyly
- extra digits of the toes
- usually involve lateral ray
- Transmitted Autosomal Dominant - +ve FHx
- May involve extra phalanges or even duplication of rays
What is the tx of polydactyly?
- Operative
- Ablation of extra digit ( usually border)
- peform at 9-12 months old
- small skin tags can be removed in newborn nursery
What is this?
- Oligodactylyl
- Congential absence of toes
What is oligodactyly associated with?
- Fibular Hemimelia
- tarsal coalition
What is the tx of Oligodactyly?
- Non operative
- no tx required
What is this?
-
Congential deformity characterised by a 5th toe that overlaps 4th
- Overlapping toe
- Usually bilateral
- may cause problems with shoewear
What is the tx of overlapping 5th toe?
Non operative
- Initial tx is passive strecthing and buddy taping
Operative
- Tenotomy
- Dorsal capsulotomy
- Syndactylization the 4th toe- McFarland procedure
What is this?
- Congential curly toes
- common congential deformity
- flexion and varus deformity of the interphalangeal joints
- Usually involves Lateral 3 toes
- Usually Bilateral
What is the common cause of congential curly toes?
- contracture of the flexor digitorium longus (FDL) or flexor digitorium brevis (FDB)
What is the symptoms of congential curly toes?
- Asymptomatic
What is the tx of congential curly toes?
- Non operative
- Observation
- usually asymptomatic requires no tx
- toe strapping not beneficial
- Observation
- 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
-
Surgical soft tissue release
Describe the technique for surgical soft tissue release of FDL in congential curly toes?
- 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
What is this?
- Brachymetatarsia
- Congential hypoplasia of one or more metatarsals
- Shortening of 4th MT- most common
- Often Bilateral
What is the tx of brachymetatarsia?
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
What is this?
- Local Gigantism
- Macrodactyly
- may affect entire limb
What is the epidemiology of Local Gigantism?
- Rare
- congential
- Neurofibromatosis
- Proteus syndrome
- Kippel- Treuaunay - Weber
- Acquired
- Amyloidosis
- Elephantiasis ( Filariasis)
- AV malformation
- Tumour
- Acromegaly
What is are the symptoms and signs of local giantism?
- Symptoms
- Pain
- Signs
- enalarged digit/limb
What is the tx of local giantism?
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
