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DEROTATIONAL FIFTH TOE ARTHROPLASTY
This procedure is performed in situations where the fifth toe has a tendency to rotate and bend towards the fourth toe (instead of being straight and parallel to the fourth toe). Because of the bending inward, or varus position of the toe, the outside of the toe is pressed against the shoe and a corn may form.
The goals of this procedure is to remove a small piece of bone so that there is no longer "bone to shoe contact", which is creating the corn. Additionally, the incision is made in such a manner that when the incision is closed, it has a tendency to make the fifth toe straighter.
HAMMERTOE INTERDIGITAL FUSION
In this procedure the cartilage on each end of opposing bone is removed, usually with a bone saw. The resulting smooth bone on each side is pressed together and fixated (stabilized) with an insertion of a K-wire. The wire is left in for approximately three weeks in order to allow the two ends of bone to fuse together.
The final result is a rigid toe that will not bend. This procedure is reserved for severe hammertoe deformities where otherwise the toe would eventually bend again, thus causing pain.
If the resultant fused toe is longer than the toes next to it, then there is a chance a corn will form on the end of the toe.
PEG AND HOLE ARTHROPLASTY
In this procedure the end of one bone is remodeled in the shape of a peg, while the bone in front of it has a hole created within it. The peg is "placed" into the hole. This creates a rigid fusion of the toe, so it will no longer bend. Sometimes a wire may also be placed in the surgical site for better fusion. The wire is eventually removed.
This procedure is generally reserved for severe hammertoes where the toe is bent upwards and a lesser procedure might result in a recurrence.
It should be noted that this type of procedure will leave the toe very straight which at times can be a mixed blessing. From a cosmetic standpoint the toe will be very straight while the adjacent toes may still have a bend in them.
Secondly, even though this procedure will shorten the toe somewhat, if the end result of the surgery leaves the toe longer than the rest, there is a good chance a corn will develop on the end of the toe.
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