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The pathological anatomy of claw and hammer toes
1Hospital for Joint Diseases, Orthopaedic Institute, New York, N.Y. 10003.
Insights
Surgical correction for claw and hammer toes may require more extensive soft tissue release than previously thought. Understanding the specific pathology of each toe deformity is key to optimizing surgical outcomes.
Area of Science:
- Orthopedic surgery
- Foot and ankle anatomy
- Surgical pathology
Background:
- Claw and hammer toes are common foot deformities affecting the lesser digits.
- Current surgical approaches vary, with optimal treatment based on underlying pathology not fully elucidated.
Purpose of the Study:
- To determine the optimal surgical treatment for claw and hammer toes (excluding the hallux).
- To correlate specific pathological anatomy with surgical correction strategies.
Main Methods:
- Dissection of 33 fresh-frozen below-the-knee amputation specimens.
- Included 10 normal feet, 14 with claw toes, 6 with hammer toes, and 3 with uncategorized deformities.
- Sequential sectioning of soft tissues (skin, tendons, capsule, ligaments) to assess joint range of motion changes.
Main Results:
- Identified contributions of skin, tendons, joint capsule, and collateral ligaments to metatarsophalangeal and proximal interphalangeal joint deformities.
- Documented changes in joint mobility after each dissection stage.
Conclusions:
- Surgical correction of claw and hammer toes may necessitate more extensive soft tissue release than previously believed.
- A detailed understanding of the specific anatomical contributions to each deformity is crucial for effective surgical planning.
Abstract:
We sought to determine the optimum surgical treatment of claw and hammer toes (except for the hallux) on the basis of the specific pathological anatomy of each type of deformity. We dissected thirty-three fresh-frozen specimens that had been obtained from below-the-knee amputations. The specimens included ten normal feet, fourteen feet that had claw toes, six feet that had hammer toes, and three feet that had an uncategorized deformity. The contributions of abnormalities of the skin, tendons, joint capsule, and collateral ligaments to deformity of the metatarsophalangeal and proximal interphalangeal joints were determined by sequential sectioning of all of those soft-tissue components. Any alteration in the range of motion of the joints was recorded after each stage of the dissection. The findings of this study suggested that surgical correction of claw and hammer toes may necessitate more extensive sectioning of the soft tissues than had previously been believed.