Comparative analysis of outcomes of multiplanar static forefoot deformity accompanied by flexible second mallet toe deformity treated with various techniques

Abstract

Introduction

Complicated multiplanar static forefoot deformities can occur at any age ranging 72 % to 80 % in older patients significantly reducing the quality of life. The results of treatment of flexible mallet toe deformity of "smaller" toes cannot be considered satisfactory with floating toe syndrome reported in 20–54 % of cases.

The objective of the study was to evaluate the effectiveness of the original technology offered for the treatment of complicated multiplanar static forefoot deformities which differs from traditional methods by the way the plantar plate of "smaller" toes is restored.

Material and methods

The study included 43 patients who were divided into two groups depending on the type of reconstruction performed. Long-term outcomes were evaluated at 12 months of surgery using AOFAS questionnaire, radiology, VAS and the Hamilton-Thompson metatarsophalangeal “drawer test”.

Results

Conventional surgical technology applied for patients of group A and group B allowed reduction of the M1-M2 angle by 7.2 ± 1.1 degrees and visual elimination of the the second mallet toe deformity in all cases. There was no floating toe noted among patients of group B, and the deformity was defected in 5 (27.8 %) patients of group A; contracture of the second metatarsophalangeal joint diagnosed in 1 (4.0 %) patient of group B and in 8 (44.4 %) cases of group A.

Conclusion

The flexible mallet toe deformity of the second toe treated with the technique we developed allowed us to avoid the development of floating toe syndrome, contracture of the second metatarsophalangeal joint and improve the quality of life by 28.7 ± 2.4 AOFAS score.