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Flexor digitorum brevis transfer for floating toe prevention after Weil osteotomy: a cadaveric study
Lydia C Lee1, Timothy P Charlton, David B Thordarson
1University of Southern California, Los Angeles, CA, USA.
Foot & Ankle International
|August 28, 2013
Summary
Floating toe deformity after Weil osteotomies may be prevented by transferring the flexor digitorum brevis tendon to the proximal interphalangeal joint. This technique may restore the windlass mechanism, improving surgical outcomes.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Foot and Ankle Anatomy
Background:
- Floating toe deformity is a common complication following Weil osteotomies.
- This deformity is often attributed to the failure of the windlass mechanism due to metatarsal shortening.
- Proximal interphalangeal (PIP) joint arthroplasty or fusion may be indicated alongside Weil osteotomies.
Purpose of the Study:
- To investigate the role of metatarsal length and flexor digitorum brevis (FDB) tendon transfer in preventing floating toe deformity.
- To evaluate the effect of FDB tendon transfer on the metatarsophalangeal (MTP) joint angle in a cadaveric model.
Main Methods:
- Fourteen cadaveric foot specimens were utilized.
- Metatarsal length was altered to assess its impact on MTP joint angle.
- The FDB tendon was transferred to the PIP joint arthroplasty site to evaluate its effect on MTP joint alignment.
Main Results:
- Changes in metatarsal length significantly altered MTP joint angle, but without a clear dose-response relationship.
- Transferring the FDB tendon to the PIP joint resulted in significant plantarflexion of the MTP joint.
- This FDB tendon transfer effectively corrected the floating toe deformity in the cadaveric model.
Conclusions:
- Metatarsal length alteration, potentially through the windlass mechanism, is implicated in the development of floating toe deformity.
- Tensioning and transferring the FDB tendon to the PIP joint appears to be a viable strategy for preventing this deformity.
- Further research is needed to refine prevention and correction techniques for floating toe deformity.
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