Interphalangeal joint lengthening arthrodesis for the treatment of the flail toe

Flail toe is a bothersome complication following PIP resection arthroplasty, usually as a result of excessive bone resection. Patients complain of toe instability and catching on socks or shoes. We describe a PIP joint lengthening arthrodesis using structural bone graft for treatment of this condition.

The results of 13 toe lengthening arthrodesis procedures in 13 patients were reviewed. Twelve patients were available for final followup, ranging from 6 to 70 (average, 31) months.

Relief of instability symptoms occurred in all of the patients. The union rate was 75% (9/12 toes). Infection occurred in four patients, all treated successfully with oral antibiotics and pin removal when necessary. Two patients presented with ischemic complications in the tip of the toe which resolved spontaneously with good final results. Eleven of 12 patients were satisfied with the procedure and stated that they would do the surgery again.

We believe toe lengthening arthrodesis is a good salvage operation for a flail toe following PIP resection arthroplasty.