Orthopedic Case 1

HAMMER TOES

This is a thirty-three year old runner who presents with pain on the second toe. No trauma is related. No previous surgery of thefoot has been noted. Gross presentation of the toe is noted Shoe wear does seem to aggravate the discomfort of the second toe.

On physical examination, dorsiflexion of the ankle does seem to extenuate the deformity. This is noted to be a flexible deformity at the DIP, PIP, and MCP joints Dorsiflexion of the ankle encourages dorsiflexion at the MCP joint and flexion of the DIP and PIP joints. X-rays demonstrate the dorsiflexed posture of the second MCP joint.

Commentary: Flexible hammer toes as noted respond extremely well to a Girdlestone-Taylor tendon transfer. There is no need for condylectomy because by definition the deformity is flexible and will be corrected with soft tissue balancing of the toe. The transfer reduces the extrinsic pull from the profundus tendon and supports the intrinsic function of the lumbricals and interossei, that is plantar flexion of the MCP joint.