Symptoms :

• painful to walk ;
• difficulty to put shoes on.

Diagnosis :

• clinically deviation on the outside of the big toe ; formation of an exostosis on the inside of the foot which is painful and the skin is often inflamed.
• X-ray confirms the deformities.

Treatment :
The treatment must be initially medical by firstly putting a soft brace between the big toe and the second toe to reposition the big toe. The other method is to use an orthopaedic in-step to relieve the pressure.

If all theses therapeutic methods have not generate improvement, then surgery can be discussed.

Principle :
To reposition the big toe ; there are several techniques proposed :

• the first technique acts on the first metatarsus requiring a section of this bone and this technique impose implanting material to stabilise the repositionment ;
• the second technique acts by transferring the tendon, this technique is preferable used and described in this document. A tendon (the big toe abductor) is positioned on the outside of the first phalange and retracts progressively causing the movement of the big toe towards the outside of the foot. The principal of this operation consists of detaching this tendon and fixing it to the internal articulation capsule, which allows the reposition of the big toe.

It should be specified that all these operations have a common gesture which is that to remove the exostosis.

Advantages :

• quick operation ;
• no material implanted ;
• to walk quickly again on the heal after the operation ;
• the operation is carried out without hospitalisation (entering the morning and exiting the afternoon).

Limits :
The limits of the tendon transfer in the event of a rigid deformation in the big toe, and in the event of advanced osteoarthritis (wear of the cartilage), necessitates an arthrodesis to reposition the big toe which consists of removing the worn cartilage and repositioning the first phalange on the first metatarsian. This technique offers the same advantages as the tendon transfer apart from the need for putting provisional pins in to stabilise the repositioning.

Clinical example :


View before the operation : the big toe is deviated towards
the outside with an exostosis.

View after the operation : the toe is repositioned
and the exostosis is removed.

 

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