0
Research Papers

Advantages and Drawbacks of Proximal Interphalangeal Joint Fusion Versus Flexor Tendon Transfer in the Correction of Hammer and Claw Toe Deformity. A Finite-Element Study

[+] Author and Article Information
Javier Bayod1

Group of Structural Mechanics and Materials Modelling (GEMM), Aragón Institute of Engineering Research (I3A),  Universidad de Zaragoza, María de Luna s/n, E-50018 Zaragoza, Spainjbayod@unizar.es

Marta Losa-Iglesias

Faculty of Health Sciences, Rey Juan Carlos University, Avda, Atenas s/n, Madrid 28023, Spain

Ricardo Becerro de Bengoa-Vallejo

Facultad de Medicina, Ciudad Universitaria, Pabellón 2, Avda. Complutense s/n, Madrid 28040, Spain

Juan Carlos Prados-Frutos

Medicine Faculty, Complutense University, Madrid 28040, Spain

Kevin T. Jules

 New York College of Pediatric Medicine, New York, NY 10035

Manuel Doblaré

Group of Structural Mechanics and Materials Modelling (GEMM), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, E-50018 Zaragoza, Spain;Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)

1

Corresponding author.

J Biomech Eng 132(5), 051002 (Mar 24, 2010) (7 pages) doi:10.1115/1.4001115 History: Received November 13, 2009; Revised January 15, 2010; Posted January 27, 2010; Published March 24, 2010; Online March 24, 2010

Correction of claw or hammer toe deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical toe.

FIGURES IN THIS ARTICLE
<>
Copyright © 2010 by American Society of Mechanical Engineers
Your Session has timed out. Please sign back in to continue.

References

Figures

Grahic Jump Location
Figure 3

Lateral view of the finite element biomechanical model of the foot in which the osseous elements, cartilage, ligaments, plantar fascia, and FDL and FDB tendons can be seen

Grahic Jump Location
Figure 4

Loads in the anatomical model during the push-off phase of gait. (left) Area of action of the loads in the talus (shaded area). (right) Distribution of the surgical loads in the model of finite elements. Fn indicates normal force to the joint surface; Ft, tangential component of force to this surface.

Grahic Jump Location
Figure 5

Displacement of the proximal phalanges (U3) in millimeters. (a) Oblique view of the displacement of the proximal phalanges with no intervention performed, with the red color showing the most displacement. (b) Oblique view of the foot in which transfer of FDB tendon to the dorsal aspect of the proximal phalanx of the second toe has been simulated. FDL tendon remains in its normal anatomical arrangement. (c) Oblique view of the foot in which transfer of the FDL tendon to the dorsal aspect of the proximal phalanx of the second toe has been simulated. FDB tendon remains in its normal anatomical arrangement. (d) Proximal interphalangeal joint fusion.

Grahic Jump Location
Figure 6

Maximum compression stresses withstood in the plantar area of the three phalanges in the second toe in the finite element model (S) in MPa. (a) Plantar view with no intervention performed. (b) Plantar view in the model in which transfer of the FDB tendon to the dorsum of the proximal phalanx of the second toe has been simulated. FDL tendon retains its normal anatomical arrangement. (c) Plantar view in the model in which transfer of the FDL tendon to the dorsum of the proximal phalanx of the second to fifth toes has been simulated. The FDB tendon retains its normal anatomical arrangement. (d) Proximal interphalangeal joint fusion.

Grahic Jump Location
Figure 7

Maximum traction stresses withstood in the dorsal area of the three phalanges of the second toe in the finite element model in the three models analyzed. U3: traction stress scale in MPa. (a) Dorsal view in the model with no intervention performed. (b) Dorsal view in the model in which transfer of the FDB tendon to the dorsum of the proximal phalanx of the second toe has been simulated. The FDL tendon retains its normal anatomical arrangement. (c) Dorsal view in the model in which transfer of the FDL tendon to the dorsum of the proximal phalanx of the second toe has been simulated. The FDB tendon retains its normal anatomical arrangement. (d) Proximal interphalangeal joint fusion.

Grahic Jump Location
Figure 8

Diagram of mallet toe deformity (a) and radiography (b) of a mallet toe as a complication of arthrodesis performed after proximal interphalangeal joint fusion was performed for claw toe. DIP indicates dorsal interphalangeal.

Grahic Jump Location
Figure 2

Distinction between the mesh of finite elements of (a) cortical bone and (b) spongy bone, where the osseous surface of the talus can be observed

Grahic Jump Location
Figure 1

Sites of corn, pain, or ulcer appearance due to excessive pressure

Tables

Errata

Discussions

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In