[Extensor digitorum longus transfer in flexible overlapping fifth toe deformity]

Abstract

Objective: Pain relief through realignment of the fifth toe by dorsomedial capsular release at the fifth metatarsophalaneal joint and transfer of the extensor digitorum longus tendon to the aponeurosis of the abductor digiti quinti muscle.

Indications: Flexible overlapping fifth toe deformity.

Contraindications: Fixed deformity. Angular toe deformity distal to the metatarsophalangeal joint (e.g. delta phalanx). Lateral drift of all lesser toes.

Surgical technique: Dorsolateral approach to the fifth metatarsophalangeal joint. Release of the dorsomedial capsule. Tenotomy of the fifth extensor digitorum longus tendon at the dorsum of the foot. Transfer of the distally based tendon around the proximal phalanx to the aponeurosis of the abductor digiti quinti muscle. Correction of the deformity by tensioning the tendon graft appropriately.

Postoperative management: Ambulation with full weightbearing in a postoperative shoe. Toe alignment dressing for 6 weeks.

Results: A total of 48 patients (56 feet; average age 37 years) with a flexible overlapping fifth toe deformity were followed up after soft tissue release and transfer of the extensor digitorum longus tendon; 40 patients (48 feet) were re-evaluated clinically after 11.4 months (range 9-26 months). Postoperative complications were sensory disturbance at the lateral side of the fifth toe (n = 5), superficial wound slough (n = 3). Follow-up results included broad and hypertrophic scars at the fifth metatarsophalangeal joint (n = 16), physiological alignment of the fifth toe in 37 feet (77.1%), overcorrection (interdigital space 4/5 > 3 mm) in 4 feet (8.3%), undercorrection in 7 feet (14.6%). In 4 feet the undercorrection could be attributed to a Tailor's bunion deformity, which was not treated appropriately.