title: Surgical correction of claw toe deformity following harvesting of fibula flaps.
abstract: Complications after the harvesting of vascularized fibula grafts are rare. Here we present our results on patients who developed claw deformity of the great and lesser toes. We discuss the etiology of claw toe deformity and the surgical correction of this condition. Seven patients developed claw toe deformity in the donor side foot after the harvesting of a vascularized fibula graft. They comprised 5 males and 2 females with an average age of 29 years (range: 6-59 years). The affected toes in 6 patients were 1 and 2, or 1, 2, and 3. All toes were affected in the remaining patient. Four patients underwent Z-lengthening of the flexor hallucis longus at the medial malleolus of the ankle, while 3 underwent cutting of the tendons. The average time between harvesting a fibula graft and development of claw toe deformity was 13 months (range: 2.5-42 months), and the average follow-up time was 30 months (range: 10-47 months). Claw deformity of affected toes was successfully corrected in all patients by release of the flexor hallucis longus. Full extension of the affected toes was achieved by the time of final follow-up. Flexion of the interphalangeal joint was preserved in all patients except one who underwent cutting of the tendon beneath the metatarsophalangeal joint. Lengthening or cutting of the flexor hallucis longus tendon at the medial malleolus successfully corrects claw toe deformity following the harvesting of vascularized fibula grafts. Even after cutting the tendon, flexion of the great toe is possible by interconnection with the flexor digitorum longus tendon.
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan. muramatu@yamaguchi-u.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ihara
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuwabara
authors.forename: Kenzo
authors.initials: K
authors.lastname: Fujii
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005360:Fibula / Q000637:transplantation*; D037801:Hammer Toe Syndrome / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome