- Overlapping Toes:
- involves an dorsal-adduction deformity of the 5th toe;
- other components of the deformity include external rotation of the digit, contracture of the
EDL tendon;
- in some cases there may be dislocation of the MTP joint;
- often the deformity is familial and bilateral;
-
clinical findings:
- the deformity is asymptomatic, but it can cause difficulty with shoe wear and pain over the dorsum of the toe;
- a dorsal callus is commonl;
- in some cases, there will be an associated
bunionette;
-
DuVries Correction:
- may use lateral incision from osteotomy or may make second incision in 4th interspace;
- release the
EDL, dorsal joint capsule, and medial collateral ligament;
-
Butler's Surgical Correction:
- create a dorsal racket incision over the little digit, centered over the
EDL tendon;
- this allow the toe to be derotated;
- a second "handle" incision is made on the plantar aspect of the original wound, which is brought laterally and proximally;
- this incision allows the toe can now be moved laterally and plantarly;
- release the contracted extensor tendon and the dorsal capsule;
- in some cases, the plantar capsule will have to be released thru the dorsal capsule;
- for a good surgical result, the toe must passively lie in a corrected position;
- forced correction may place tension on the digital vessels;
- if residual deformity is present, more capsule needs to be excised;
- skin sutures can help keep the toe in a derotated position;
- in the report by Thordarson et al, the auhtors report on 3 patients treated with a simpler
procedure involving metatarsal phalangeal capsular release dorsally and medially,
oblique lengthening of the extensor tendon, and Z-plasty of the skin;
- ref: Congenital crossover fifth toe correction with soft tissue release and cutaneous Z-plasty.
Thordarson DB. Foot Ankle Int 2001 Jun;22(6):471-7
- Curly Toes:
- involves malrotation of one or more toes along w/ digit flexion deformity;
- in contrast,
hammer toes are generally not mal-rotated;
- may be due to contracture of
FDL and
FDB;
- common disorder in children
- look for symmetric deformity in the opposite foot;
- treatment:
- involves
FDL tenotomy at age 3-4 years;
- with more severe deformity consider
Girdlestone Taylor Procedure
- References:
Butler Arthroplasty for Correction of the Adducted Fifth Toe:
A retrospective study
of 36 operations between 1968-1982.
GB Black MD et al.
Journal of Pediatric Orthopaedics. Vol 5. No 4. 1985. p 439.
Butler's operation for overriding fifth toe.
J. Cockin.
JBJS Vol 50-B. 1968. p 78-81.
Surgical syndactylia of the toes.
Kelikian H. et al.
CORR. Vol 19. 1961. p 208.
Surgery for curly toe deformity: double-blind, randomised, prospective trial.
Hamer AJ.
Stanley D.
Smith TW.
Journal of Bone & Joint Surgery - British Volume. 75(4):662-3, 1993 Jul.
