surgical algorithm

Fixation

Definition

 

Garden 1 / 2

 

Algorithm

 

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

 

Options

 

Cannulated screws

DHS + derotation screw

 

3 cannulated screws

 

Management

Surgical Algorithm

 

Stage 1 Tendonitis

 

Non-operative

 

Walking cast / NSAIDS

- 6/52

 

UCBL

- 3/12

- worn inside the shoe

- ends under malleoli

- controls the heel (which must be flexible)

- supports the arch

 

Operative / Synovectomy and debridement

(+/- FDL transfer and calcaneal osteotomy +/- T Achilles lengthening)

Management

Non-Operative

 

Education regarding shoe wear

- extra wide / large toe box

 

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

 

Toe spacers

 

Analgesia

 

Operative

 

Indications

 

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Claw Toe

Definition

 

Hyperextension of MTPJ and PIPJ / DIPJ flexion

- usually all toes affected 

 

Claw Toes

 

DDx

 

1.  Complex hammer

- hammer toe with MTPJ extension

- hammer usually affects second toe

 

2.  Curly toe

Tendonitis / Tendonopathy

Anatomy

 

Lateral compartment of leg

- run through retromalleolar groove

- pass superior and inferior to peroneal tubercle

- covered by inferior peroneal retinaculum

 

Peroneus longus

- origin lateral condyle of tibia and head fibula

- tendon PL superficial and inferior to brevis in retromalleolar groove

- runs in cuboid groove 

- insert plantar surface base of 1st MT and lateral aspect medial cuneiform