by Al C. Kline, DPM
I’ve used a number of techniques over the years to correct hammer toes and mallet toes. Many times, hammertoes and mallet toes are corrected by digital arthrodesis or fusion. Classically, before the newer implants were designed, simple Kirschner wires were used to fuse digital deformities.
Hammer toe correction using Kirshner wires or K-wires was first described by Higgs in 1931 and pioneered by Taylor and Sheffield in the 1940’s. Kirshner wires still have their place and are often still used in digital fusions. However, many patients do not like the idea of a wire sticking out of the end of the toe. Also, there are other risks including pin tract infections and non-unions. Fortunately, many of the newer implants eliminate the need for external pins.
I still use Kirschner wires today in some cases. I use them mainly when the contracture of the toe is so severe, that after proper release and reduction, I can use the wire to help stabilize the toe in a more plantarflexed position while healing. Even the newer cannulated implants can provide the surgeon with the same ability.
One of the newest implants used today is the Phalinx® implant by Wright Medical™. This device is one of the best implants I’ve ever used for digital arthrodesis or fusion. Because it is cannulated, it also allows me to use a pin if I deem it necessary to help stabilize the toe.
The Phalinx® implant is manufactured out of implant grade titanium and available in four sizes. Many times, I use the extra small cannulated staight implant for my distal interphalangeal joint fusions (for the mallet toe) and either a angulated or straight small or medium cannulated implant for the proximal interphalangeal joint fusions (for the hammer toe).
The implant is contraindicated in patients with infection, irreparable tendon damage, pediatric patients with growing epiphyses and some patients with high level of sport or activity.
I want to share with you 2 cases that I performed recently using the implants for both a traditional hammer toe correction and a not-so-traditional correction for a mallet toe deformity. Mallet toe deformities are common and often the surgeon will simply remove a part of the joint to correct the deformity. However, sometimes, persistent swelling can result in a simple arthroplasty. Fusions provide a much more stable joint and will eliminate persistent swelling sometimes associated with arthroplasty where the joint is not fused.
The x-ray on the left shows a typical hammer toe correction using the Phalinx® implant. The x-ray on the right shows the extra-small implant when used to fuse the mallet toe deformity. This is one of the few implants that works for such a small joint fusion without the need to use a Kirschner wire. The cannulated center still allows the surgeon to use a pin if needed to further stabilize the toe.
I typically will not use the pin, but rather a taping technique post surgically using simple tape and steri-strips. This will help to stabilize the toe in a more plantarflexed position if needed after soft tissue release of the contracture without the need for a pin. The patient is able to walk immediately after surgery with a post-operative shoe. Fusion will take 6-8 weeks.