Girdlestone-Taylor Flexor Extensor Tendon Transfer

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Abstract

ABSTRACT

In the treatment of deformities of the lesser toes, we have to differentiate between hammer and claw toes. The term ″hammertoes″ refers to a flexion deformity of the proximal interphalangeal joint of the lesser toe, in which the distal interphalangeal joint is in the neutral or extended position. The term ″claw toes″ refers to a deformity in which there is a flexion deformity of the proximal interphalangeal and distal interphalangeal joints, and there is an extension deformity of the metatarsophalangeal joint. A determination has to be made as to how flexible or fixed the deformities are. This will dictate the treatment. The cause for these deformities can be neuromuscular, congenital, or acquired (overload, traumatic, etc.). Neuromuscular causes are the most frequent. After a thorough history and physical examination, which has to include the circulatory and neurologic status of the extremity, radiographs are needed to evaluate the magnitude of the bony deformities. Initial treatment of a flexible hammer or claw toe is conservative, which will include stretching exercises, accommodative shoe wear, and splinting techniques. After failure of an adequate conservative treatment, surgical treatment is indicated. A flexible hammer or claw toe is amenable to a flexor-to-extensor transfer, which will correct the deformity. If there is a fixed deformity of the proximal interphalangeal joint, a resection arthroplasty can be added to the tendon transfer. If the metatarsophalangeal joint is fixed, a soft-tissue release, which includes a tenotomy and capsulotomy, can be added to the transfer. Good to excellent results can be expected in 80% to 90% of the cases. Stiffness of the proximal interphalangeal joint can be encountered in as many as 60% of the cases.

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