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A 60 y/o female with hyperextension at the PIPJ and DIPJ of digits 2 and3 bilateral. Literally bearing weight on plantar PIPJ's. s/p DIPJ arthroplasty and flexor tenotomy in spring 06'. MRI reveals long flexor tendon visable and head of proximal phalanx. Looking for ideas on correction. Considering reattachment of flexor on plantar proximal phalanx with micro mitek anchor, extensor tendon lengthening and PIPJ arthroplasty. Thoughts?
Wow. I have not yet seen this complication following a simple DIPJt arthroplasty / flexor tenotomy but I am not sure from this account exactly what surgery was done with particular reference to the flexor tenotomy (long/short flexor/level etc) and or how the rest of the foot is working. On the face of it I would worry about persistent digital instability issues and would probably settle for a digital arthrodesis with extensor - flexor tendon balancing.
I quite agree with Deiter here. IMO if complications follow surgery, it is always best to keep review surgery as simple as possible. Aim to correct the hyperextension at both joints (it must be an interesting foot, any chance of an image?) and leave the tendons alone unless lengthening absolutely necessary to bring the entire digit into neutral at the MTPJ. Arthrodesis seems to be the best bet for achieving the desired outcome.
Performed surgery....intra-op revealed a middle phalanx that was completely dislocated. The articular cartilage on the base of the middle phalanx was facing dorsally and sitting above articular surface of the proximal phalanx. I needed a flat surface to abut against the remaining shaft of the proximal phalanx (had to do PIPJ arthroplasty to decompress toe and access long flexor tendon). Found flexor tendon and split...half medial, half lateral and transferred dorsally around shaft/base of proximal phalanx. Loaded the foot and had toe plantarflexion. K-wire fixation....
Hammertoe complication
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