Results of using Helal osteotomy for surgical correction of the hammer toe

Introduction. The variety of types of small toes static deformities and the absence of a unified list of objective deformity indicators complicate it classification and affect on treatment outcomes. Thorough analysis of the hammer toe surgical treatment outcomes using a specific technique will allow us to solve of these problems. The purpose of the study: to analyze the results of using Helal osteotomy for correction of the hammer second toe.

Materials and methods. Between 2018 and 2020, we performed Helal osteotomy in 40 patients with unilateral static foot deformity. These patients had a hammer toe in combination with hallux valgus. The results of the operations were analyzed in the study.

Results. The use of Helal osteotomy allowed achieving complete correction of the hammertoe deformity of the second toe in 70% of patients. This led to an improvement in the clinical and functional parameters of the second toe. However, residual deformation of the toe was observed in 30% of cases, stiffness in the second metatarsophalangeal joint in 27.5 % of cases, and transitional metatarsalgia in 7.5% of cases. This indicates the insufficient effectiveness of the method. The main reason for the residual deformation of the second toe is the limited capabilities of the Helal osteotomy. These  capabilities allow correcting hyperextension of the toe in the metatarsophalangeal joint only within 18.67 ± 3.27 degrees. This is especially noticeable with a large angle of dorsal deviation.

Conclusion. The Helal osteotomy used to correct hammer toe deformities does not always produce the desired result. To more accurately select a treatment strategy and evaluate its success, it is necessary to develop a set of objective criteria based on clinical, radiographic and functional data. These criteria will allow classifying foot deformities, selecting the optimal treatment method and evaluating its effectiveness.

1. Migues A, Slullitel G, Bilbao F, Carrasco M, Solari G. Floating-toe deformity as a complication of the Weil osteotomy. Foot Ankle Int. 2004 Sep; 25(9): 609-13. https://doi.org/10.1177/107110070402500902. PMID: 15563380

2. Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchman J. Complications of the Weil osteotomy. Foot Ankle Spec. 2011 Jun; 4(3): 165-70. https://doi.org/10.1177/1938640011402822. Epub 2011 Apr 13. PMID: 21490179.

3. V.N. Cherevcov, A.N. Blazhenko, S.B. Bogdanov, V.S. Kireev, A.V. Gorohov Comparative analysis of the results of treatment of multiplanar static deformity of the forefoot, accompanied by non-rigid hammertoe deformity of the second toe by various methods Genij ortopedii. 2022; 28 (3): 361-366. https://doi.org/10.18019/1028-4427-2022-28-3-361-366. EDN HTWVWT. (In Russian)

4. Uritani D., Sakamoto C., Fukumoto T. Effect of floating toes on knee and trunk acceleration during walking: a preliminary study. J. Phys. Ther. Sci. 2017; 29 (2): 361-364. https://doi.org/10.1589/jpts.29.361.

5. Kurihara T, Yamauchi J, Otsuka M, Tottori N, Hashimoto T, Isaka T. Maximum toe flexor muscle strength and quantitative analysis of human plantar intrinsic and extrinsic muscles by a magnetic resonance imaging technique. J Foot Ankle Res. 2014 May 5; 7: 26. https://doi.org/10.1186/1757-1146-7-26 PMID: 24955128; PMCID: PMC4049512.

6. Tadzh, V. G. Procko, V. N. Cherevcov, A. V. Volkov Comparison of the results of helical and lateral osteotomies for the treatment of metatarsal fractures in secondary metatarsal joints of the 2nd, 3rd and 4th metatarsal bones] Dnevnik Kazanskoj medicinskoj shkoly. 2017; 3 (17): 54–61. (In Russian)

7. Konkel KF, Sover ER, Menger AG, Halberg JM. Hammer toe correction using an absorbable pin. Foot Ankle Int. 2011 Oct; 32 (10): 973-8. https://doi.org/10.3113/FAI.2011.0973. PMID: 22224327.

8. Losa Iglesias ME, Becerro de Bengoa Vallejo R, Jules KT, Trepal MJ. Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities. J Am Podiatr Med Assoc. 2012 Sep-Oct; 102(5): 359-68. https://doi.org/10.7547/1020359. PMID: 23001729.

9. Zazіrnij, І. M. Metatarsalgia: pathogenesis, biomechanics and surgical treatment] Travma. 2020; 21 (4): 57-64. https://doi.org/10.22141/1608-1706.4.21.2020.213063 EDN QPFGIX. (in Ukrainian)

10. Harwin SF, Charen DA, Markowitz JS, et al. Overview of Metatarsalgia. Orthopedics. 2019; 42(1): e138-e143. https://doi.org/10.3928/01477447-20181206-06

11. Trnka HJ, Mühlbauer M, Zettl R, Myerson MS, Ritschl P. Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints. Foot Ankle Int. 1999 Feb; 20(2): 72-9. https://doi.org/10.1177/107110079902000202 PMID: 10063974.

12. Gudi, S. M. Surgical correction of fixed hammertoe deformity of the small toes: diss. Cand. of Medicine Novosibirsk, 2020: 128. (In Russian)

13. S. N. Leonova, I. V. Usol'cev Method of surgical treatment of hallux valgus: medical technology] Irkutsk: INCHT, 2016: 20. (In Russian)

14. V. N. Cherevcov, A. A. Tadzh, V. G. Procko, S. K. Tamoev Lechenie sindroma central'noj metatarzalgii [Treatment of central metatarsalgia syndrome] Sovremennaja nauka: aktual'nye problemy teorii i praktiki. Serija: Estestvennye i tehnicheskie nauki. 2017; 7-8: 139–144. (In Russian)]

15. S. N. Leonova, I. V. Usol'cev, M. A. Kosareva, N. A. Pozdeeva. Sposob opredelenija polozhenija golovok pljusnevyh kostej: metodicheskie rekomendacii po primeneniju novoj medicinskoj tehnologii [Method for determining the position of the heads of the metatarsal bones: guidelines for the use of a new medical technology] Irkutsk: INCHT, 2023; 20. (In Russian)

16. Mo TS., Rigin N.V., Bobrov D.S., Slinyakov L.YU. Ankety i shkaly dlya otsenki sostoyaniya stopy i golenostopnogo sustava. Kafedra travmatologii i ortopedii 2016; 4(20): 5-11.

17. Baumhauer, J.F., et al., Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int. 2006; 27 (12): 1014-9. https://doi.org/10.1177/107110070602701202

18. Pinsker, E. and T.R. Daniels, AOFAS Position Statement Regarding the Future of the AOFAS Clinical Rating Systems. Foot & Ankle International, 2011; 32 (09): 841-842. https://doi.org/10.3113/FAI.2011.0841

19. Chan HY, Chen JY, Zainul-Abidin S, Ying H, Koo K, Rikhraj IS. Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery. Foot Ankle Int. 2017 May; 38(5): 551-557. https://doi.org/10.1177/1071100716688724. Epub 2017 Feb 13. PMID: 28193121.