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
surgical algorithm
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
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