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Book Review - A Review of Hammertoes: A Case-Based Approach

One of the less enjoyable surgical pathologies for some podiatrists are hammertoe repairs. Many surgeons have indicated their frustration with these procedures for a variety of reasons including an inability to attain consistent results, difficulties with the very small anatomy, and common complications such as flail toe or lack of toe purchase. Of course, along with the challenges of digital deformities comes their very significant contribution to disease of the foot. For example, many diabetic forefoot amputations stem from unaddressed hammertoe deformities.

I’m in the camp of those who don’t love fixing these problem children of the feet, and I’ve never been happy with the surgical options available. When I was trained, hammertoe correction consisted essentially of removing a toe joint, fusing a toe joint, and/or releasing the metatarsophalangeal joint. Recognition of the contribution of the plantar plate improved surgical options, but there remain many challenges to overcome. The sheer number of options and new technologies points to the difficulty of this problem. Recently, I’ve been on the lookout for new resources to help me be a better surgeon, so I was excited to come across an excellent text, Hammertoes: A Case-Based Approach1 edited by doctors Emily and Jeremy Cook.

The sheer number of surgical options and new technologies points to the difficulty of getting an optimal result in the surgical repair of hammertoes.

For those not familiar with the doctors Cook, Emily and Jeremy are a power podiatric couple who have done excellent work over more than a decade in practice, and I’ve enjoyed watching their leadership grow. The Cooks have been performing lower extremity research and publishing on a variety of important topics for years, have lectured at large conferences, and started the Mount Auburn Hospital Podiatric Medicine and Surgery Residency, in Cambridge, Massachusetts, a program with an excellent national reputation. Their deep resumé now includes the publication of a new textbook to help all of us become better at handling a difficult pathology.

Hammertoes: A Case-Based Approach has 29 chapters, with contributions by a virtual who’s who of national podiatric surgical leadership, covering almost all procedure options and clinical situations from various types of PIPJ arthrodesis to plantar plate repairs and plastic surgical options, among many others. The book begins with three well-written chapters covering important anatomical and biomechanical principles and then moves into the various surgical options.

The chapters are concisely written, making this a resource that may be rapidly referred to or leisurely read

True to the title of this textbook, each chapter is structured around one or more actual cases, rather than some hypothetical situation. The many color images are high quality, as are the nicely illustrated figures. Surgical techniques are well described, and each chapter contains a discussion of clinical pearls and pitfalls. Despite being amply illustrated, the chapters are concisely written, making this a resource that may be rapidly referred to or leisurely read. The easy readability of the text as well as its emphasis on principles increases the readership to include students, residents, and advanced practitioners. There are intriguing discussions of new ideas for each of us.

I would be remiss if I failed to point out possible areas of improvement. Although there was an excellent discussion about the contribution of the first ray to hammertoe deformities, I wasn’t able to find content that covered the involvement of metatarsus adductus. Although the textbook is almost entirely about surgery, a chapter covering nonsurgical treatment principles may have been beneficial to many readers (although one must concur that the nonsurgical options are relatively limited). Perhaps the title should have been Hammertoe Surgery. Finally, the text is laid out almost like a list of options detailing the various procedures, placing all options on equal footing. This equal approach prevents the appearance of preferring one technique or technology over another, an academically sound approach. But this leaves out one important and rarely discussed principle: decision making (why and how to choose one type of procedure or technology over another). This is more a reflection of the absence of this topic in the podiatric community rather than a specific downfall of the textbook. If I had to make one very unrealistic request, it would be to create a series of videos of selected surgical procedures as an added resource so we can see them in action.

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These very small issues in no way detract from the content, and this well-written and illustrated book that provides a broad and highly practical real-life approach to a very difficult clinical problem should be on the shelves of anyone seriously interested in repairing hammertoes. I congratulate Drs Emily and Jeremy Cook, as well as the individual chapter authors, on a work of excellent scholarship and contribution to the field.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
  1. Cook EA, Cook JJ. (Eds). Hammertoes: A Case-Based Approach. Switzerland:Springer Nature;2019.
    LINK to Scroll Through and Purchase Book on Amazon

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