The modified Robert Jones tendon transfer in cases of pes cavus and clawed hallux

This is a retrospective study of the modified Robert Jones tendon transfer in 24 patients and 28 feet. The main indication for the procedure was to correct symptoms related to clawing of the hallux in seven patients, relieve pressure under the head of the first metatarsal in 13 patients, and treat for both symptoms in three patients. One patient had diffuse ache in the arch. Fifteen patients had idiopathic cavus feet, of whom five had associated spina bifida occulta. The remainder had a variety of different etiologies including cerebral palsy, head injury, brain abscess, and spinal cord tethering. Postoperative follow-up ranged from 7 months to 33 years with an average of 5 years and 6 months. The modified Robert Jones tendon transfer was shown to be effective in relieving symptoms related to clawing of the hallux in 90% of patients but was not reliable in curing pain under the first metatarsal head, with success in only 43% of patients. In three patients, pain under the metatarsal head was relieved initially but recurred by 18 months. Complications were frequent. Six patients developed pain under the tip of the hallux postoperatively.