Hammertoes pp 375-386 | Cite as

Lesser Metatarsal-Phalangeal Joint Fusion as an Adjunctive Procedure for the Treatment of the Complex Hammer Digit

  • Robert Joseph


Lesser metatarsal-phalangeal joint fusion is a less common but highly effective adjunct procedure for the treatment of the complex hammer digit. The complex hammer digit is a multi-planar deformity that presents as a flexion contracture of the digit with subluxation or dislocation of the metatarsal-phalangeal joint (Fig. 26.1 complex hammer digit). This is distinguished from the simple hammer digit that presents as a flexion contracture of the digit without metatarsal-phalangeal joint instability (Fig. 26.2 simple hammer digit). Metatarsal-phalangeal joint pathology is not only the hallmark difference between the complex and simple hammer digits but the critical indication for adjunct procedures that stabilize the metatarsal-phalangeal joint when performing hammer digit correction surgery. Neglect of metatarsal-phalangeal joint instability when surgically correcting the complex hammer digit may result in a higher incidence of floating toe syndrome or recurrence of deformity. Hence joint fusion and techniques such as plantar plate repair and flexor tendon transfer procedures are essential for the treatment of the complex hammer digit.


  1. 1.
    Myerson MS, Jung HG. The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. Foot Ankle Int. 2005;26:675–9.CrossRefGoogle Scholar
  2. 2.
    Umans HR, Elsinger E. The plantar plate of the lesser metatarsophalangeal joints: potential for injury and role of MR imaging. Magn Reson Imaging Clin N Am. 2001;9:659–69. xiiPubMedGoogle Scholar
  3. 3.
    Deland JT, Sung IH. The medial crosssover toe: a cadaveric dissection. Foot Ankle Int. 2000;21:375–8.CrossRefGoogle Scholar
  4. 4.
    Goldner JL, Ward WG. Traumatic horizontal deviation of the second toe: mechanism of deformity, diagnosis, and treatment. Bull Hosp Jt Dis Orthop Inst. 1987;47:123–35.PubMedGoogle Scholar
  5. 5.
    Mendicino RW, Statler TK, Saltrick KR, Catanzariti AR. Predislocation syndrome: a review and retrospective analysis of eight patients. J Foot Ankle Surg. 2001;40:214–24.CrossRefGoogle Scholar
  6. 6.
    Deland JT, Lee KT, Sobel M, DiCarlo EF. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int. 1995;16:480–6.CrossRefGoogle Scholar
  7. 7.
    Fortin PT, Myerson MS. Second metatarsophalangeal joint instability. Foot Ankle Int. 1995;16:306–13.CrossRefGoogle Scholar
  8. 8.
    Bhatia D, Myerson MS, Curtis MJ, Cunningham BW, Jinnah RH. Anatomical restraints to dislocation of the second metatarsophalangeal joint and assessment of a repair technique. J Bone Joint Surg Am. 1994;76:1371–5.CrossRefGoogle Scholar
  9. 9.
    Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization. Clin Podiatr Med Surg. 2011;28:57–68.CrossRefGoogle Scholar
  10. 10.
    Lehman DE, Smith RW. Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis. Foot Ankle Int. 1995;16:535–41.CrossRefGoogle Scholar
  11. 11.
    Mesiha M, Zurakowski D, Soriano J, Nielson JH, Zarins B, Murray MM. Pathologic characteristics of the torn human meniscus. Am J Sports Med. 2007;35:103–12.CrossRefGoogle Scholar
  12. 12.
    Gregg J, Marks P, Silberstein M, Schneider T, Kerr J. Histologic anatomy of the lesser metatarsophalangeal joint plantar plate. Surg Radiol Anat. 2007;29:141–7.CrossRefGoogle Scholar
  13. 13.
    Ellington JK, Jones CP, Cohen BE, Davis WH, Nickisch F, Anderson RB. Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int. 2010;31:385–90.CrossRefGoogle Scholar
  14. 14.
    Karlock LG. Second metatarsophalangeal joint fusion: a new technique for crossover hammertoe deformity. A preliminary report. J Foot Ankle Surg. 2003;42:178–82.CrossRefGoogle Scholar
  15. 15.
    Hamilton GA, Ford LA, Patel S. First metatarsophalangeal joint arthrodesis and revision arthrodesis. Clin Podiatr Med Surg. 2009;26:459–73. Table of ContentsCrossRefGoogle Scholar
  16. 16.
    Stainsby GD. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl. 1997;79:58–68.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Johnston RB 3rd, Smith J, Daniels T. The plantar plate of the lesser toes: an anatomical study in human cadavers. Foot Ankle Int. 1994;15:276–82.CrossRefGoogle Scholar
  18. 18.
    Bouche RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg. 2008;47:125–37.CrossRefGoogle Scholar
  19. 19.
    Hansen ST. Functional reconstruction of the foot and ankle in. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 31.Google Scholar
  20. 20.
    Heinegard D, Saxne T. The role of the cartilage matrix in osteoarthritis. Nat Rev Rheumatol. 2011;7:50–6.CrossRefGoogle Scholar
  21. 21.
    Joseph RM. Osteoarthritis of the ankle: bridging concepts in basic science with clinical care. Clin Podiatr Med Surg. 2009;26:169–84.CrossRefGoogle Scholar
  22. 22.
    Amalinei C, Caruntu ID, Giusca SE, Balan RA. Matrix metalloproteinases involvement in pathologic conditions. Romanian J Morphol Embryol. 2010;51:215–28.Google Scholar
  23. 23.
    Jeffries LC, Rodriguez RH, Stapleton JJ, Zgonis T. Pan-metatarsophalangeal joint arthrodesis for the severe rheumatoid forefoot deformity. Clin Podiatr Med Surg. 2009;26:149–57.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Robert Joseph
    • 1
  1. 1.Department of Podiatric Medicine and RadiologyScholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Health SciencesNorth ChicagoUSA

Personalised recommendations