Podiatry | Emergency Injury Repair for a Big Toe
Emergency treatment for injuries can involve surgery, such as the work done in this video. The patient suffered a lawnmower injury. The damage was extensive to the big toe. We were able to accomplish repair and avoid future issues such as infection.
As a podiatrist, my practice deals with various foot conditions that are congenital or are developed over time. Other conditions do involve injury such as sports injuries. Some of these are emergency treatment while others are treated after they’ve been bothering the patient for a period of time.
My practice is aimed at providing care for patients’ feet in the full spectrum of need. I am ready and equipped to offer emergency treatment or to offer long term treatment. I have experience with surgeries that can relieve conditions where in the past only the painful symptoms received treatment.
MBA Implant for Pediatric Flatfoot | Video
Surgery is performed to correct a pediatric flatfoot deformity. This specific implant is a MBA subtalar implant. It acts as an internal arch support and works very well. It is often done with a Gastroc Recession.
At the YouTube channel, several viewers were kind enough to leave their comments and questions. One of the latest commented on the absence of blood during the surgery. The response was that we use a tourniquet to cut off circulation for a short time during surgery and avoid blood loss.
We frequently video procedures to inform patients and share procedural views with colleagues.
The Benefits of Locking Plates for Foot and Ankle Surgery
A colleague shared an opinion about locking plates for orthopedic surgery, “the most significant advancement in 25 years.”. His comment coincided with my opinion about locking plates after 20 years of practice.
I wrote a blog post at Podiatry Today about the ways locking plates offer change for the outcome of any type of foot surgery, whether forefoot or other types of foot and ankle surgery.
A patient, going into the process of foot surgery, may not be professionally informed about the parts and pieces for adding plates or screws. In my opinion, using locking plates gives my patients at Hoosier Foot and Ankle a lead on a good result.
That is my responsibility to be as informed and skilled as I can possibly be for the successful experience of my patients. I am also interested in informing other practitioners so that they may provide the best for their patients. The blog post at Podiatry Today is straight forward, more interesting and informative to other podiatrists, to be sure. It is my intention that professional podiatry have information about processes that have been successful (or not successful) for me.
Additionally, I’m happy that I have learned the benefits of applying locking plates in the procedures that I perform for my patients.
Hammer toe answers
Hammer toes are a contracture of the toe at one or more of the toe joints. There are many causes of hammer toes, but typically a biomechanical abnormality that lead to a tendon imbalance is the primary cause. A contracture of the joint closest to the toenail is called a mallet toe. A hammer toe is a contracture of the second joint of the toe and is the most common digital deformity. A claw toe is a combination of a hammer toe and mallet toe. The metatarsal joint may be contracted with any of the above deformities. From a clinical and treatment standpoint, the most important factor is if the deformity is flexible or rigid.
Treatment options are really limited for hammer toes. If the deformity is flexible, you can treat the biomechanical abnormality that led to the deformity typically with a custom orthotic. If this is not a viable option, then a surgical procedure called a flexor tendon transfer is an excellent choice. This involves rerouting the long tendon on the bottom of the toe to the top of the toe. This changes this tendon from a deforming force to a corrective force. For a rigid deformity the options are surgical or live with the deformity (working around it with a wider, boxier shoe). Surgically the two choices are arthroplasty or arthrodesis. For completeness sakes, implant arthroplasty is also a possible treatment option for this deformity. I do not use implants for hammer toes unless there is a flail (floppy toe) deformity.
I have gone back and forth over my career between arthrodesis and arthroplasty, primarily because I have not been completely satisfied with either procedure. For mallet toes, arthroplasty is the primary choice. Hammer toes are much more common and will be discussed for the remainder of this blog. Arthrodesis provides a more predictable result, but often times the toe is too straight. Arthrodesis means fusion of the the two bones that make up the joint. Typically this is held in place with a pin that goes through the toe and is left in for six weeks. Arthroplasty just means removal of the end of the first bone. This is also held in place with a pin for three to six weeks. This procedure tends to provide a little more normal appearance to the toe, but the toe can shift once the pin is removed.
A newer modification arthrodesis procedure is the use of the Smart toe implant instead of a pin to hold the toe in alignment. The Smart toe has a straight and angled design. The straight design also makes the toe too straight in my opinion. I am a big fan of the angled design, which puts the toe in about a 10 degree downward position. This provides a more normal appearing toe and the toe tends to sit on the ground better. The implant stays in permanently and provides stability. The Smart toe is made by MMI and more information is available at http://www.hammertoetreatment.com/mmi_smarttoe/index.html
If you have a hammer toe deformity, first have it evaluated by a podiatrist. Ask what your treatment options are. If you are having pain, corn formation, difficulty wearing shoes or redness; a surgical procedure may be the best option. Ask about the type of procedure being recommended. Ask why that procedure is being recommended. Ask if the doctor has any experience with the Smart toe implant. I hope this helps give you some guidance for you treatment of your hammer toe.
Patrick A. DeHeer, DPM