The original joint-saving technique for the treatment of hammer-toe deformity

Background. Hammertoe deformity is characterized by extension contracture of the metatarsophalangeal joint, flexion contracture of the proximal interphalangeal joint, and hyperextension of the distal interphalangeal joint. This condition is widespread, especially among women in the older age group. Hammertoe deformity, both isolated and in combination with concomitant foot deformities, is a pathology that leads to a decrease in the activity of patients, severe pain and difficulties in choosing shoes. Existing surgical treatment methods have disadvantages and limitations in application, which leads to the need to search for new treatment methods.

Aim. Analysis of short-term results of using an original joint-saving technique for the treatment of hammertoe deformity – Oblique Distal Osteotomy (KDO) using an immersion fixator.

Materials and methods. To assess the objective condition of the patient in the pre- and postoperative periods, radiographs were taken, photographs and video recordings were made to determine the range of motion in the Proximal interphalangeal joint (PIPJ). To assess the subjective state of the patient before treatment and 6 months aſter surgery, a survey was performed using the visually analog scale (VAS), AOFAS Forefoot (AOFAS FF) questionnaires and questions regarding the patients’ subjective assessment of the treatment performed.

Results. According to the survey data, a decrease in the level of pain syndrome is noted, and an increase in the patient’s activity is determined. The VAS score before treatment was 5.8 (4–7, SD=1.0) points, 6 months aſter surgery it was 1.4 (0–2, SD=0.8, p <0.05) points. Questionnaire results using the AOFAS FF scale increased from 80.4 (69–90, SD=7.7) to 91 (83–95, SD=4.1, p <0.05) points. 20 patients (83.3%) were satisfied with the cosmetic and functional results. In all patients, control radiographs showed consolidation of the osteotomy zones; no signs of migration of fixators were recorded. The range of motion in the foot joints in the group of patients at the time of control examinations was: in the PMJ joint — 17,9 ° (7 ° –30 °, SD= 6.4).

Conclusion. Short-term results of treatment of patients with hammertoe deformity using the KDO technique allow us to conclude that the results in the short-term postoperative period are satisfactory, the necessary correction of the deformity is achieved while maintaining movements in the proximal interphalangeal joints.

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