CLAW OR HAMMER TOES ORIGIN TREATMENT AND OPERATIONS.?

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Claw toes are a common toe condition affecting mainly women over the age of 50. This is one of the primary reasons for specialist consultations. Depending on the shape adopted by the toes, we speak of a claw or hammer deformation, depending on the joints affected. With the development of knowledge on the subject, this classification gradually loses its interest and we now try to recognize the flexible, semi-rigid or rigid character of the deformation, depending on the ability to easily restore the toe in its normal position.

The toe is normally in a position of extension of its own joints and this essentially depends on the balance of the tendons of the foot. Indeed, the mobility of the different joints is ensured by tendons attaching to the phalanges and which, by their traction, allow flexion or extension of each joint. It is a delicate balance where each tendon must be compensated by the others so that the toe maintains its normal position at rest.

If only one of these tendons is more powerful or simply shortened, we quickly note the development of a deformation in flexion or extension due to the loss of this tendinous balance and an inability of the body to compensate for the retraction. The shape of the toe will then depend on the affected tendon(s).

Most of the time, we will first note a retraction of the flexors of the toe which will cause flexion of the first interphalangeal joint. In a second step, a deformation of the metatarsophalangeal joint can develop, therefore at the root of the toe, which will cause the characteristic claw shape. In this position, the toe will quickly become awkward in the shoes due to the hyper-support between the interphalangeal joint and the shoe and we will note the development of a corn (or callus), which is basically only a thickening of the skin to protect the toe from this support (see Fig1). The pain appears quickly, especially when the toe stiffens. It is at this stage that many patients request a consultation,

When conservative treatment is no longer sufficient, surgical management can be undertaken.

The classic techniques of correction consist of arthrodesis of the proximal interphalangeal joint, ie the excision of the cartilage and the placement of pins during the healing time. This intervention has long been the only option and it remains the most performed surgery today.

During a percutaneous correction, the dressing is of particular importance because it is this which will allow the toes to be perfectly reoriented and to have them heal in the correct position. The dressing is therefore changed every week for 4 weeks by the surgeon or a specialized nurse.

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