title: Flexor digitorum brevis transfer for floating toe prevention after Weil osteotomy: a cadaveric study.
abstract: BACKGROUND
  A floating toe deformity occurs in many patients who undergo Weil osteotomies. It is likely caused by the failure of the windlass mechanism in shortening the metatarsal. For patients who require a proximal interphalangeal (PIP) joint arthroplasty or fusion in addition to a Weil osteotomy, the transfer of the flexor digitorum brevis (FDB) tendon to the PIP joint might restore the windlass mechanism and decrease the incidence of floating toes.
  
  
  METHODS
  Fourteen cadaveric foot specimens were examined to determine the effects of changing metatarsal length as well as tensioning the FDB tendon on the angle of the metatarsophalangeal (MTP) joint as a measure of a floating toe.
  
  
  RESULTS
  Shortening and lengthening the second metatarsal resulted in a significant change in MTP angle (P = .03 and .02, respectively), though there was no clear relationship found between the amount of change in metatarsal length and the change in MTP angle. Transferring the FDB to a PIP arthroplasty site plantarflexed the MTP joint and corrected floating toes; the change in angle was significant compared with the control and shortening groups (P = .0001 and .002, respectively).
  
  
  CONCLUSIONS
  This study supports the theory that change in length of the metatarsal, possibly via the windlass mechanism, plays a role in the pathophysiology of the floating toe deformity. Tensioning and transferring the FDB tendon into the PIP joint helped prevent the floating toe deformity in this cadaveric model.
  
  
  CONCLUSIONS
  Continued research in this subject will help to refine methods of prevention and correction of the floating toe deformity.
authors: University of Southern California, Los Angeles, CA, USA.
authors: Lydia C
authors: LC
authors: Lee
authors: Timothy P
authors: TP
authors: Charlton
authors: David B
authors: DB
authors: Thordarson
mesh_terms: D001178:Arthroplasty; D002102:Cadaver; D005531:Foot Deformities, Acquired / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008682:Metatarsal Bones / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods*; D013709:Tendon Transfer; D014033:Toe Joint / Q000601:surgery*
keywords: Weil osteotomy; floating toe; forefoot disorders; metatarsal; windlass mechanism