James W Gallentine1, James K DeOrio. 1. Mayo Clinic, Department of Orthopaedics, 4500 San Pablo Rd, Jacksonville, FL 32224, USA. deorio.james@mayo.edu
Abstract
BACKGROUND: Our hypothesis was that amputation of an isolated, painful second hammertoe is beneficial and has less morbidity than forefoot reconstruction when other associated deformities are not clinically painful. The objective was to evaluate the clinical outcomes of elderly patients undergoing amputation of painful second hammertoes instead of advanced reconstructive procedures. METHODS: We retrospectively reviewed all cases of removal of the second toe through the MTP joint for painful hammertoe deformities from May, 1998 to May 2004. Amputation for ischemic disease was excluded from the study. No patient had a concurrent hallux valgus reconstruction. The study group included 12 patients (17 amputations). A clinical questionnaire was used to determine patient satisfaction and postoperative changes in forefoot alignment. RESULTS: Ten patients were satisfied with the results, and the other two were satisfied with reservations. The activity level improved for nine patients. Eight patients noted continued valgus drift of the great toe. Nine patients would have the procedure again, and 11 thought that it met their expectations and would recommend it. No important complications were noted. CONCLUSIONS: Amputation of the second toe in elderly patients is acceptable for complaints of pain related solely to the hammertoe. The morbidity associated with more advanced reconstruction is avoided, while eliminating pain and improving shoe-wear and function. Patient satisfaction was high, and complications were minimal. Drift of the great toe into valgus did not appear to be a clinical problem.
BACKGROUND: Our hypothesis was that amputation of an isolated, painful second hammertoe is beneficial and has less morbidity than forefoot reconstruction when other associated deformities are not clinically painful. The objective was to evaluate the clinical outcomes of elderly patients undergoing amputation of painful second hammertoes instead of advanced reconstructive procedures. METHODS: We retrospectively reviewed all cases of removal of the second toe through the MTP joint for painful hammertoe deformities from May, 1998 to May 2004. Amputation for ischemic disease was excluded from the study. No patient had a concurrent hallux valgus reconstruction. The study group included 12 patients (17 amputations). A clinical questionnaire was used to determine patient satisfaction and postoperative changes in forefoot alignment. RESULTS: Ten patients were satisfied with the results, and the other two were satisfied with reservations. The activity level improved for nine patients. Eight patients noted continued valgus drift of the great toe. Nine patients would have the procedure again, and 11 thought that it met their expectations and would recommend it. No important complications were noted. CONCLUSIONS: Amputation of the second toe in elderly patients is acceptable for complaints of pain related solely to the hammertoe. The morbidity associated with more advanced reconstruction is avoided, while eliminating pain and improving shoe-wear and function. Patient satisfaction was high, and complications were minimal. Drift of the great toe into valgus did not appear to be a clinical problem.