Hand rehabilitation after great toe transfer for thumb reconstruction

A comprehensive rehabilitation program for patients who have undergone a great toe to hand transfer for thumb reconstruction can significantly affect eventual functional outcome. When the thumb is amputated near the metacarpophalangeal joint, such a transfer provides a useful and aesthetic thumb substitute. Goals of rehabilitation are to promote optimal functioning of the reconstructed hand by maximizing range of motion, preventing reduction of the first web space, facilitating adequate sensory return, and maximizing strength, coordination, and endurance. Therapeutic modalities include edema control, passive and active exercises, static and dynamic splinting, massage, sensory reeducation, and graded functional activities. Emotional adjustment and vocational adaptation are additional therapeutic concerns. Case histories of two patients are briefly reviewed along with pre- and posttransfer assessments of range of motion, strength, sensation, and dexterity.