title: A novel modification of the Stainsby procedure: surgical technique and clinical outcome.
abstract: BACKGROUND
  The 'Stainsby procedure' is an effective salvage procedure for correction of fixed claw toe deformity. A novel approach is described involving the extensor tenotomy step of the procedure, which is easier, faster and safer to perform.
  
  
  METHODS
  A retrospective single surgeon review was performed to assess this modification. 37 patients (92 lesser toes in 42 feet) underwent the modified Stainsby procedure. Mean follow-up was 17 months. Patients were interviewed and examined at a dedicated review clinic. American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and Foot and Ankle Outcome (FAO) scores were calculated.
  
  
  RESULTS
  Significant improvements in end-points including metatarsalgia, callosity and requirement for insoles or chiropody were noted. Median AOFAS and FAOS scores following the modified Stainsby procedure are reported and compare favourably to previously reported scores. Median FAOS scores were as follows: 92 for the category of pain, 84 for symptoms and stiffness, 96 for activities of daily living, 100 for sports and recreation and 81 for quality of life. Median AOFAS forefoot score was 80. There was a low rate of wound infection of 2.7% (n=1).
  
  
  CONCLUSIONS
  We describe a novel technical modification to the Stainsby procedure and our results support the use of this modification, following assessment of patient outcome. However, limitations to this study were noted in terms of the length of follow-up, the absence of pre-operative clinical scores for comparative purposes, and the variety of surgical procedures performed concomitantly on the 1st ray.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Ireland. Electronic address: lizconcannon@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Concannon
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: MacNiocaill
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Flavin
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Kearns
mesh_terms: D000368:Aged; D002145:Callosities / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D061826:Foot Orthoses / Q000706:statistics & numerical data; D006215:Hallux Valgus / Q000601:surgery*; D037801:Hammer Toe Syndrome / Q000601:surgery*; D006801:Humans; D008297:Male; D037061:Metatarsalgia / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016879:Salvage Therapy; D013710:Tendons / Q000601:surgery
keywords: Claw toe deformity; Hallux valgus; Metatarsalgia; Rheumatoid forefoot; Stainsby