Gregory J. Kramer, DPM, FACFAS
Ankle and Foot Associates
of Southern Georgia
 Anatomy
 Classification
 Etiology
 Treatment
 Surgical
 Arthroplasty vs. Arthrodesis
 OrthoPro Screw
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 Osseous Structures
 Soft Tissue Structures
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 Metatarsal
 Head
 Shaft
 Base
 Phalanges
 Proximal
 Middle
 Distal
 Head
 Shaft
 Base
 Articulations
 Metatarsal Phalangeal Joint (MPJ)
 Proximal Interphalangeal Joint (PIPJ)
 Distal Interphalangeal Joint (DIPJ)
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 Tendons
 Extrinsic
 Extensor digitorum longus
 Flexor digitorum longus
 Intrinsic
 Extensor digitorum brevis
 Flexor digitorum brevis
 Dorsal and Plantar Interossei
 Lumbricles
 Quadratus plantae
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 Classic Hammertoe
 Claw Toe
 Mallet Toe
 Rigid
 Flexible
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 Genetic
 Acquired
 Shoe gear
 Trauma
 Biomechanical
 Flexor Stabilization
 Flexor Substitution
 Extensor Substitution
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 Conservative
 Surgical
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 Shoe modification
 Accommodative padding
 Orthotic devices
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“You have this”
“We are going to give you this”
“Is it really that simple?”
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 Soft Tissue Procedures
 Osseous Procedures
 Sequential Release
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• Tenotomy
• Extensor tenotomy and capsulotomy
• Flexor tenotomy and capsulotomy
• Flexor tendon transfer
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 Resection of base
of proximal phalanx
 Syndactylization
 Arthroplasty
 Arthrodesis
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 Most common procedure performed for
hammertoe correction
 May or may not require fixation
 Usually requires addition of soft tissue procedures
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 Types of fixation
 K-wire
 Absorbable rod
 Implants
 Shaw rod
 Ship implant
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 Usually requires addition of soft tissue procedures
 Is not performed on the fifth digit
 Requires fixation
 Types of fixation
 K-wires (smooth or threaded)
 Screws
 Various implants
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 End to End
 Peg in hole
 Insitu
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Arthroplasty
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Most common procedure performed for
hammertoe correction
Technically easy procedure
Some motion is retained
Shortening of digit is inherent to
procedure
May be unstable
Increased chance of recurrence of
hammertoe deformity
Fixation
 K-wire
 Implant
Indications
 Flexible to semi – rigid deformity
Athrodesis
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Not as common
Technically more difficult procedure
No motion, toe is rigid
Maintains relative length of digit
Stable
Minimal chance of recurrence
Longevity of correction
Fixation
 Screw
 Threaded or Smooth K-wire
 Implant
Indications:
 Loss of Intrinsic muscle stability
 Diabetes
 Neuromuscular conditions
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 Technically easy
 No exposed K-wire
 Less chance of pin tract infection
 No need to remove the pin at a later date
 Less chance of bending or breaking of the pin
 Quicker return to bathing and shoe gear
 Provides superior compression
 Provides stability even in the face of pseudoarthrosis
 Stabilizes both distal and proximal interphalangeal joints
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 Don’t try to be an expert on procedure choice
 Be the expert on your implant
 Know the technical aspects of your implant
(i.e. lengths, diameter, etc.)
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