Function after correction of a clawed great toe by a modified Robert Jones transfer.

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Biomechanics

Background:

• Clawed hallux associated with cavus foot often requires surgical correction.
• The modified Robert Jones tendon transfer is a common surgical approach.
• Understanding the long-term outcomes and potential complications is essential for patient management.

Purpose of the Study:

• To evaluate the clinical and radiological outcomes of the modified Robert Jones tendon transfer for clawed hallux with cavus foot.
• To identify the rate of patient satisfaction and complication incidence.
• To analyze risk factors associated with specific complications.

Main Methods:

• A cross-sectional study involving 51 patients (81 feet) with clawed hallux and cavus foot.
• Patients underwent modified Robert Jones tendon transfer with concomitant procedures.
• Clinical and radiological evaluations were performed at a mean follow-up of 42 months.

Main Results:

• 86% patient satisfaction and successful hallux deformity correction in 80 feet.
• Common complications included catching of the big toe, transfer lesions, metatarsalgia, hallux flexus, hallux limitus, and asymptomatic nonunion.
• First ray elevation was linked to hallux limitus (p=0.012) and peroneus longus to brevis transfer (p<0.0001).

Conclusions:

• The modified Robert Jones transfer effectively addresses the extensor hallucis longus deforming force.
• However, it alters first metatarsophalangeal joint mechanics, potentially leading to complications like hallux limitus.
• Management of clawed hallux requires a comprehensive approach considering muscle balance and first ray stability.