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DPM,MA
Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)
Section:  Surgery

Don't get me wrong, I admire those whom have adopted the latest procedures in correcting patients pedal digital maladies. 

However, of late, I have observed a few patients with toe implants following hammertoe surgical correction that have resulted in rigid medial or lateral deviations.  These deviations at the PIP joint are now in a fixed position, and the toe is well healed.  However, the patient complains of impingement upon the adjacent toe.  That is, they are suffering abrasions, callouses, if not blistering, and of course pain.

The other problem I observed in another patient recently was a long 2nd toe (with an implant) relative to the hallux and much longer relative to "curly toes" 3-4-5.  It did not look right at all, and while the patient seemed to walk without difficulty on gait exam, the parabola was incorrect.

I still subscribe to the traditional K-wire fixation, that is removable, as I prefer to NOT leave anything behind.  This is a school of thought that is shared by many a foot surgeon.

Anyhow, my question is, because obviously I never graduated to this advanced level of toe implant surgery, despite having attended the lectures and even the workshops at various conferences throughout the 2000's is this:  HOW IS THIS RIGID, FIXED MEDIAL OR LATERAL DEVIATION REVERSIBLE?

One solution I have seen by an expert advanced implant and other technological applications in surgery podiatric foot surgeon was this:  whenever the patient returns to clinic with the same repeat complaint was to dispense a couple of those nifty little foam toe web space dual colored (orange - yellow) pads with some paper tape.

Now, the patient is married to applying this pad everyday as part of their morning routine lest they incur lesion and pain.  Plus, it is visible when they wear sandals or slippers.

Anyone's expert thoughts would be appreciated here...

Thank you.

WG

100_0036

MEMBER COMMENTS
Re: Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)
Quote:
Don't get me wrong, I admire those whom have adopted the latest procedures in correcting patients pedal digital maladies. 

However, of late, I have observed a few patients with toe implants following hammertoe surgical correction that have resulted in rigid medial or lateral deviations.  These deviations at the PIP joint are now in a fixed position, and the toe is well healed.  However, the patient complains of impingement upon the adjacent toe.  That is, they are suffering abrasions, callouses, if not blistering, and of course pain.

The other problem I observed in another patient recently was a long 2nd toe (with an implant) relative to the hallux and much longer relative to "curly toes" 3-4-5.  It did not look right at all, and while the patient seemed to walk without difficulty on gait exam, the parabola was incorrect.

I still subscribe to the traditional K-wire fixation, that is removable, as I prefer to NOT leave anything behind.  This is a school of thought that is shared by many a foot surgeon.

Anyone's expert thoughts would be appreciated here...

WG

The question here is whether or not there is enough evidence of a high level and longitudinal nature beyond the companies lauds and some short term, anecdotal and low level evidence that should sway surgeons, hospitals, surgicenters and patients to make the switch from the K-wires, or even non fixation, that have served us so well in the past?

Are there studies comparing K-wires to any of these new permanent implants?

On Wikopedia, for instance when referencing the Smart Toe Implant it states:
"it corrects the failure and implantation problems associated with K-wires and previous generations of implants, delivering highly positive outcomes with faster healing and few complications".  

1. It fails to mention any complications as does Dr. Godfrey.

2. It fails to offer any evidence on behalf of its claims even though Wikopedia asks for it.

I am not questioning the viability of this new generation of implants or them eventually becoming evidence based.  I am simply asking if they are currently Evidence Based?

Dennis

Re: Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)

WG, I don't beleive they are easily removable devices. And the  complications? I can't conceive of how to correct them without massive surgery for the volume of a toe.

That's why I don't use them.

Dave Gottlieb, DPM

views expressed are my own and no one else

Re: Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)

This conversation took place over breakfast at the House of delegats In New York. One doctor who likes the smarttoe implant stated he will make a bone cut at the level of the pipj was. he then will grasp the center pieve and pull with force. he stated "its still the medually canal and with some force it will come out".

That was the first time hearing all it needed was a little force. I have heard from others "it is not so easy, you have to cut away a window" - now that would scare me, as per Dave's point of not a lot of real estate there and potential for sausage toe or even vascular compromise could be real.

If anyone reading does these and has had to remove them - please chime in.

Solange (a medical company) has a product called the tensfuse which is a one piece allograft that resembles a french fry that can be used for arthrodesis of a toe.

Re: Re: Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)
Quote:

Solange (a medical company) has a product called the tensfuse which is a one piece allograft that resembles a french fry that can be used for arthrodesis of a toe.

 


The Tenfuse seems like a clever idea but the cost is stupid-expensive. One could buy well over a thousand 0.045 k-wires for the same price.

Re: Hammertoe Repair Implant - Complications: How are they reversible? (vs. good old fashioned removable K-wire)

Point well taken.