Hammertoe correction with k-wire fixation. Although fusion of the DIPJ is a sound primary procedure, it would seem prudent to reserve PIP fusion as a revision procedure [7] or for the treatment of severe, fixed hammer toe . Brief definitions to orthopedic terminology arranged topically in 12 chapters. --> Arthroplasty of toe with synthetic joint prosthesis 65813003. Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis. 26 (4):320-5. Toe Arthroplasty. They may be caused by trauma (stubbing the toe and producing a fracture or tear of the tendons that straighten or extend the toe). This book is written and intended for both, trainees and established arthroplasty surgeons who are dedicated to perform a well-cemented THA. J Foot Ankle Surg. 0
CPB 0708 - Metatarsal Phalangeal Joint Replacement. 1979;50:709-712. 1996;13(2):263-268. J Foot Surg. 2007;28(4):422-430. Foot Ankle Int. The affected tendons are cut and then reattached to conform to the new, correct toe position. Definitions of hammer toe and claw toe: An evaluation of the literature. It is also possible to indicate where the injury occurred. Wright Foot & Ankle. You could use CPT 28899 (unlisted procedure). padding: 10px; Codingline Response: The correction of a hammertoe deformity is coded as CPT 28285. Bartee SL, Midenberg M. A modified arthroplasty procedure for rigid hammertoe. Gretchen Baumhover, Office Manager Office of Paul H. Eisenberg, D.P.M. However, percutaneous Kirschner wire fixation is associated with potential complications, including wire migration, breakage, and pin tract infection. The claw toe is the DIP joint; the hammertoe is the PIP joint. Hammer toe operation 127601009. A PIP joint arthroplasty uses bone fusion to alleviate pain and correct the hammer toe Tailor's Bunion 5th Toe . Richman SH, Siqueira MB, McCullough KA, Berkowitz MJ. Deformity after prior arthroplasty and at least ONE of the following: a. If you perform CPT 28285 (correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) on the 2nd through 5th toes, and, additionally, needed to perform a "w-plasty," "z-plasty" or "v-y" skinplasty to lengthen the skin because of dorsal lesser metatarsal-phalangeal joint skin contractures, can you bill CPT 28285 + CPT 14040 (adjacent . specimens with fixed claw or hammer toe deformities. 1996;13(2):211-218. Ann R Coll Surg Eng. CHAPTER 24 127 perform a middle phalangectomy.If a middle phalangectomy were done in combination with an arthroplasry of the PIPJ, it would result in an extremely unstable, floppy toe. Over that time period, the resulting search yielded 60 patients who had 89 digital surgeries. More commonly, the deformity occurs slowly or chronically. All patients were evaluated pre- and post-operatively by American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog pain scale (VAS) scores. Query: Hammertoe + Skinplasty. Pietrzak WS, Lessek TP, Perns SV. A shoe with a wide, high toe box, soft upper shoe, and stiff sole to absorb dorsally directed forces against the plantar plate is appropriate. Found inside – Page ivThe aim of this book is to provide clinicians and medical students with basic knowledge of the most common neurosurgical disorders. Five patients were lost to follow-up, and 24 patients (42 toes) returned at an average of 12 months for final clinical and radiographic evaluation. The big toe joint can be painful when forced to move. 1993;14:385-388. Kirschner wires may be used as fixation devices for arthrodesis and arthroplasty. Surgery: A Case Based Clinical Review provides the reader with a comprehensive understanding of surgical diseases in one easy to use reference that combines multiple teaching formats. The book begins using a case based approach. Constructs were evaluated by applying a cantilever load, which simulated a plantar force on the middle phalanx. Find this course on foot procedure codes, hammertoe repair CPT codes, additional CPT coding refresher courses, and more courses to refresh coding skills on our YES Education Site. Nobody had hardware failure or required a 2nd operation. Background: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is a common, low-cost method for fixation of hammertoes after proximal interphalangeal (PIP) arthroplasty or fusion. The mean VAS pain score improved from 5 points (range of 2 to 10) pre-operatively to 1 point (range of 0 to 5) post-operatively. Breakage of the Smart Toe implant was significantly higher than that of the other fixations, with 10.6 % of implants breaking within the 1st year post-operatively; SF-36 and VAS scores decreased 12 months after surgery for the 3 types of fixation, with no statistically significant differences observed. 2014;35(4):319-325. An evaluation of operative procedures in the treatment of hammertoe. If arthroplasty is used, the surgeon will make an incision along the toe and trim the tendons that stabilize the inner toe bone, allowing the toe to straighten. Last Review 1984;5:67-73. Official guidelines and exercises for the American Medical Association's (AMA's) Physician's Current Procedural Terminology (CPT). The most common is the second toe and often accompanies a bunion as the big toe crosses under the second toe. Diagnosis is made with plain radiographs of the foot often showing joint space narrowing and dorsal osteophyte formation in the midfoot. %%EOF
Shaw AH, Alvarez G. The use of digital implants for the correction of hammer toe deformity and their potential complications and management. 28052 XU T2. All patients reported satisfaction at final follow-up, with an average improvement of AOFAS score from 52 (range of 24 to 87 points) to 71 (range of 42 to 95 points) points. Mallet toes, hammertoes, neuromas, and metatarsophalangeal joint instability: 40 years of development in forefoot surgery. Arthrex offers a line of PIP fixation options to correct hammertoe deformities. 313 0 obj
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METAL HEMI Great Toe Implant. Foot Ankle Int. April 9, 2015. I wouldn't separately code the 28092/removal of the cyst since it was done through the same incision as the more extensive 28285 - the arthroplasty.You will need to query the surgeon. Full procedural descriptions are accompanied by numerous illustrations and detailed discussion of the complications which can arise during treatment is included. Medico–legal and ethical issues are also appraised. 1). Crossover second toe deformity. All codes except the 28052's were paid. Wright leads the way with an impressive history of ground-breaking products for the foot and ankle industry. On physical examination, the location and magnitude of the deformity, callosities, and digit circumference were recorded. } The latest ones are on Aug 02, 2021 Foot Ankle Int. The 2021 edition of ICD-10-CM M20.42 became effective on October 1, 2020. While this may . A hammer toe is a potentially painful toe deformity. Provides students with a foundation of knowledge they can build on as they pursue a career in healthcare. This work is written in a user-friendly style. Query: Coding Hammertoe Correction with Implant. ACFAS position statement on cosmetic surgery. A hammertoe also can be associated with a contracture of the joint at the base of the toe and can often occur in . In claw toe, there is dorsiflexion of the proximal phalanx on the MTP joint and plantar flexion of the PIP and DIP joints. The beginning of the arthroplasty description is that a horizontal incision was made at the DIP joint of the 2nd left digit, the distal interphalageal . This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Cook JJ, Cook EA, Hansen DD, et al. Scott et al (2013) noted that hammertoe digital deformity correction is a very controversial topic among foot and ankle surgeons. This code is used is . OL OL OL OL OL LI { This study biomechanically compared a threaded/barbed bioabsorbable fixation implant made of a copolymer of 82 % poly-L-lactic acid and 18 % polyglycolic acid with a 1.57-mm Kirschner wire using the devices to fix 2 synthetic bone blocks together. 2015;54(5):910-916. In a retrospective, comparative study, Richman and colleagues (2017) compared the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). Found inside – Page iiiThis book will provide you with the basic tools to handle day-to-day situations without stress and will help you to improve your English, no matter what your level. The big toe joint is made up of two smaller bones called phalanges. This learning path provides 1.5 CEU certificates (1.5 AAPC CEUs and towards 1.5 AHIMA CEUs). Clinical Practice Guideline. Complications and fusion rates were also evaluated. unlisted foot/toe procedure code, CPT 28899, or. Flexor tendon transfer for metatarsophalangeal instability of the second toe. 1984 Sep-Oct. 5 (2):67-73. . CPT 28285 is also the. The educators are knowledgeable and make learning fun by adding real world experience examples and scenarios. Static instability and dislocation of the 2nd metatarsophalangeal joint. 1987;8:29-39. The combined hammer toe-mallet toe deformity with associated double corns: A retrospective review. The deformity gradually increases causing pain when wearing shoes and walking. 2018;57(2):332-338. 2. CPT 28285 is defined as "correction, hammertoe (e.g., interphalangeal fusion, partial. Aetna considers surgical repair of hammertoe deformity (also called claw toe, mallet toe) in skeletally mature individuals (i.e., after epiphyseal closure) or individuals who are 18 years of age or older medically necessary when the following criteria are met: Aetna considers repeat hammer toe surgical treatment medically necessary following failure of a previous surgical procedure. Another drawback of this implant is the need for wire removal and the associated patient anxiety with this in-office procedure. } In 2014, Wright transformed itself from . Tendon transfer. CPT 28285 is also the. Hammertoe surgery: Arthroplasty, arthrodesis or plantar plate repair? Foot Ankle Int. } Inflammatory conditions such as rheumatoid arthritis, gout, systemic lupus, exanthematous disease, and Reiter's disease may cause synovitis of the joints, and result in stretching or laxity of joint ligaments which allows the deformity to develop. This book is a comprehensive guide to surgery of the ankle and foot. Clin Podiatr Med Surg. Complications of this procedure include pin-tract infection, pin migration, pin bending or breakage, and recurrence of deformity. 28052 XU T4. Found inside – Page 37CODING PROCEDURE / SERVICE EXAMPLES Hammertoe Operation ( CPT 28285 ) In the context ... The term “ arthroplasty " should not be used to describe surgical ... (C) Lateral nail fold (Lister's corn). These researchers prospectively collected clinical and radiographic outcomes of operative correction of hammertoe deformity using a permanently implanted 1-piece intramedullary device. It is designated as a "separate procedure" in the CPT book. When the procedure is completed, the patient will often walk . Derotation arthroplasty is the time-tested procedure for the repair of a symptomatic adductovarus deformity of the fifth toe. 26-2. Hammer Toe is a lesser toe deformity characterized by PIP flexion, DIP extension and MTP slight extension. Foot Ankle. Hammertoes can be flexible or rigid. The text includes both clinical and administrative office examples and cases that provide a realistic context for introducing terms and definitions. 5/24/2017 8 CPT 28313 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes) •No bone of contention 5thdigit correction •Hallux varus •Abducted or adducted digit at MTPJ These findings need to be validated by additional research. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Accelerated aging at elevated temperature (47 degrees C) in a buffer solution showed that there was no reduction in mechanical properties of the bioabsorbable system after the equivalent of nearly 6 weeks in a simulated in-vivo (37 degrees C) environment. Kernbach KJ. A claw toe is a deformity of the toe in which the meta-tarso-phalangeal (MTP) joint is pulled up or extended. All of the following must be met: 1. Salvage procedure (post arthroplasty), proximal interphalangeal (PIP) joint . J Foot Ankle Surg. procedure, if not the specific technique. Operative procedures for the correction of hammertoe, claw toe, and mallet toe: A literature review. I would highly recommend YES to anyone seeking to learn about the latest and greatest on new and updated coding information! } Semin Arthroplasty. This Clinical Policy Bulletin may be updated and therefore is subject to change. If the flexion contracture is severe and of long duration, associated hyperextension of the metatarsophalangeal (MTP) joint and extension of the distal interphalangeal (DIP) joint may occur. In general, percutaneous Kirschner wires are used to provide fixation to the resected proximal inter-phalangeal joint. Post-operative radiographs indicated 100 % of proximal inter-phalangeal (PIP) joints with good alignment, and 81 % demonstrated bony union. Diagnosis is made clinically with the presence of a rigid or flexible lesser toe with PIP flexion, DIP extension and MTP slight extension. Regarding digital alignment, there were no recurrent deformities or transverse plane deformities; 1 toe presented with a minor digital rotational deformity at final follow-up. The 2021 edition of ICD-10-CM M20.41 became effective on October 1, 2020. Parrish TF. Find out when you might need it, how to get ready, and what to expect. During resection arthroplasty surgery, your doctor removes part of a joint to relieve pain and other symptoms. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Found inside – Page 101... interphalangeal resection arthroplasty • alternative fusion fixation with ... claw toes , a metatarsophalangeal capsular and tendon release ( CPT code ... American College of Foot and Ankle Surgeons (ACFAS). Recurrence of hammertoe or claw toe b. Varus or valgus deformity at proximal interphalangeal (PIP) joint 2. Well-designed studies with larger sample size and longer follow-up are needed to validate these findings. The procedure was undertaken in 19 patients, in a total of 42 toes. Throughout the book, superior in-text features provide a clear learning path to student success. Over time, your toe may curl or it may rise up and overlap with another toe. In all cases, the failure mode was bending of the implant, with no devices fracturing. Semin Arthroplasty. Wisconsin's best foot surgeons answer the questions YOU have about hammer toe surgery & work with you to minimize out of pocket costs. Found inside – Page iiIdeally suited for residents and students whether MD, DO or DPM, Essential Foot and Ankle Surgical Techniques - EFAST for short - is a dynamic, multidisciplinary resource that covers the full range of pathologies and injuries an orthopedic ... A Metatarsophalangeal Joint Capsulotomy procedure (each joint) done with or without Tenorrhaphy is coded as 28270. Kirschner wires (K-wires) have long been considered the gold standard for hammertoe digital repair. This case-series study provided level IV evidence; its findings need to be validated by well-designed studies. Because the MTP joint is always dorsiflexed by definition, some correction of its position is necessary to restore a more neutral angle at the MTP joint. August 19, 2013. The stiffness (approximately 6 to 9 N/mm) and peak load (approximately 8 to 9 N) of the constructs using the 2 systems were equivalent. Procedure 71388002. Functional outcome was assessed using the Foot Function Index (FFI), the Short Form 36 (SF-36), and the 10-point VAS validated questionnaires. Hallux rigidus (aka stiff big toe) A deformity in the joint located at the base of the big . toe and its challenges are not in the scope of this article, the point I am trying to make is that of the lateral 3 toes, the fi fth toe is quite complicated and has many factors that one needs to assess prior to performing the textbook procedure -- an arthroplasty. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Member has 1 or more of the following indications for hammertoe repair: Adventitious bursitis on the dorsal surface of the hammertoe; Ankylosis of the distal interphalangeal (DIP) joint or proximal interphalangeal (PIP) joint; Inter-digital neuroma caused by the deformity; Lateral metatarsophalangeal (MTP) capsular tear caused by the deformity; Painful nail conditions secondary to persistent trauma; Presence of co-existing or causative conditions (e.g., tendon contracture) that need repair; Subluxation or dislocation of the MTP joint; Academy of Ambulatory Foot and Ankle Surgery. Schrier JC, Verheyen CC, Louwerens JW. LPT ™ Great Toe Implant. It is the sole responsibility of Gazdag A, Cracchiolo A. Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. Found insidePerforming well on orthopedic surgery rotations during the 4th year of medical school is critical for match success. The goal of this guide book is to help students ace their orthopedic rotations. OL OL OL LI { A retrospective review of operative hammertoe correction by a single surgeon was performed in 96 patients followed for more than 12 months. There is no specific code for the de-syndactylism procedure. A total of 29 patients with 60 painful, rigid hammertoes were prospectively enrolled, clinically and radiographically examined, operatively treated, then followed and re-examined. Patients at the extremes of the age scale are perhaps less tolerant of the procedure; complaints include poor cosmesis and subjective lack of control of the toes [18]. A 2nd patient developed a painless recurrent deformity. 2012;51(4):450-456. 1992;3:31-38. MDI ™ Metatarsal Decompression Implant. Work Loss Data Institute. Symptoms of big toe arthritis include pain and stiffness in the big toe, difficulty running or squatting, and trouble fitting into shoes. OL LI { Average age was 61.7 years and 61.4 years, respectively. code CPT directs surgeons to: "For hammertoe. CPT code for arthroplasty distal interphalangeal joint toe. } During this procedure, a small piece of the bone is removed to shorten the toe and allow it to straighten. A hammer or claw toe occurs . looking for an existing code that defines the. OL OL LI { Foot Ankle. Gallentine JW, DeOrio JK. 1997;55(5):1866-1876. @media print { Stainsby GD. The total cost for treatment with percutaneous K-wire fixation was $5,041 with an effectiveness of 0.82 QALY compared with a commercial implant cost of $6,059 with an effectiveness of 0.83 QALY. Percutaneous Kirschner wire versus commercial implant for hammertoe repair: A cost-effectiveness analysis. The authors concluded that percutaneous K-wire fixation would be preferred for arthrodesis of the PIP joint for hammertoes from a healthcare system perspective. CPT code for arthroplasty distal interphalangeal joint toe. In 2014, Wright transformed itself from . Repeat hammer toe surgery is considered medically necessary following failure of a previous Interpositional arthroplasty with biologic spacers for hallux rigidus, degenerative arthritis, and other indications involving the MTP joints Foot Surgery_ CPT_ DX Coding Critieria 01_2020.pdf. This book, written by leading experts in the field, is a comprehensive guide to the best available techniques in Achilles tendon surgery. 1995;16:109-116. After greater than or equal to 18 months of follow-up, the incidence of fusion with satisfactory radiographic alignment was 85 % (51 of 60 toes). Such implants are not universally accepted and are exceedingly difficult to remove should the surgery fail. 1973;4:97-102. Copyright Aetna Inc. All rights reserved. Correction of hammer toe surgery deformity by Z-plasty and bone graft. If this sounds familiar, you could be a candidate for a CARTIVA ® SCI. device for the hammer toe procedure. 1983;22(1):40-44. To perform this procedure, your podiatric surgeon will remove a small portion of bone at the head of the proximal phalanx. CPT coding guidelines and advice from CPT Assistant, as well as real-world coding selection scenarios, will be reviewed. I wouldn't separately code the 28092/removal of the cyst since it was done through the same incision as the more extensive 28285 - the arthroplasty.You will need to query the surgeon. Correction of hammertoe deformity with novel intramedullary PIP fusion device versus K-wire fixation. 2009;99(3):194-197. Hammer toe operation 127601009. 2013;6(3):214-216. What would be the appropriate CPT-4 code for the insertion of the Weil Silastic digital implant for a hammertoe correction? Links to various non-Aetna sites are provided for your convenience only. background: #5e9732; Alvine F, Garvin KL. Fusion of the joint can be achieved with various devices, with the current focus on percutaneous K-wire fixation or commercial intramedullary implant devices. Wright leads the way with an impressive history of ground-breaking products for the foot and ankle industry. American College of Foot and Ankle Surgeons (ACFAS). Found inside – Page 252... CPT CODES 28088 Synovectomy , tendon sheath , foot ; extensor 28160 Lesser metatarsophalangeal joint resection arthroplasty 28285 Correction , hammertoe ... The Refresh With YES: CPT Feet Procedures Learning Path walks learners through an overview of CPT coding for selected feet procedures, such as arthroplasty and bone resection, divided into 21-30-minute webinars. Should we report 28285 or an unlisted code? In this procedure, the provider makes an incision to open the metatarsophalangeal joint, where the foot and toe join, and takes a biopsy of the soft tissue. Unless arthritis develops, the condition is not painful. 2003;83(3):707-726. Several patients in the study underwent corrections in different toes; thus, a total of 186 toes were included in the study. A retrospective analysis of modification of the flexor tendon transfer for correction of hammer toe. This learning path discusses the characteristics and diagnoses of additional feet procedures . Fortin PT, Myerson MS. Second metatarsophalangeal joint instability. #1. When the toe cocks up, the metatarsal bone is pushed downward, resulting in increased pressure under the ball of the foot (metatarsalgia). Chicago, IL: ACFAS; February 2013. Philadelphia, PA: Academy of Ambulatory Foot and Ankle Surgery; 2003. Wright Foot & Ankle. By releasing the tendon that is tight the deformity will be decreased. Last Review 08/26/2021. J Am Podiatr Med Assoc. Wisconsin's best foot surgeons answer the questions YOU have about hammer toe surgery & work with you to minimize out of pocket costs. } A total of 29 patients (53 toes) with a painful rigid hammertoe deformity were prospectively enrolled and operatively treated with resection arthroplasty of the PIP joint and fixation with an implant. The actual selection of codes depends upon the primary surgical procedure, supported by details in the patient's medical record about medical necessity. People with a high-arch (cavus) type foot may be prone to develop claw toes. A metatarsal bar can be added to the shoe to avoid metatarsal pressure, but patients more easily accept metatarsal pads.
Question: We are having some debate about whether CPT code 28285 (hammertoe repair) would be appropriate for fusion of a claw toe? Witt BL, Hyer CF. These preliminary findings need to be validated by well-designed studies. Witt and Hyer (2012) noted that hammertoes are common deformities that are often surgically treated using arthrodesis or arthroplasty of the proximal inter -phalangeal joint with percutaneous, temporary Kirschner wire fixation. } list-style-type: upper-roman; Surgical procedures utilized for the correction of hammer toe include, but may not be limited to, amputation for severe deformity, arthrodesis, arthroplasty, flexor to extensor tendon transfer, partial or total phalangectomy or tenotomy. Found insideGreat Health Care is enlightening and entertaining. 1990;29:176-178. procedures, it is billable using the Toe Modifiers when the Hammertoe procedure is performed on a different toe from the Bunionectomy procedure. In fact, this text could be to pain as Miller is to general anesthesia. These results suggested that the bioabsorbable implant would be a suitable fixation device for the hammer toe procedure. Procedure 71388002. You should add the appropriate "T" modifier. No serious complications were encountered, and revision surgery was required in just two cases. I need help with this procedure--Reverse Austin with 1.5x16mm screw--4 cm linear incision . Foot Ankle Int. M20.41 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. O'Kane C, Kilmartin T. Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases. Coughlin, MJ. Work Loss Data Institute. 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. Berea, OH Codingline-L Response: I would recommend that you code the hammertoe correction as CPT 28285 (plus the appropriate "T" modifier" for each repair. Found insideThis Handbook brings together experts in many different facets related to PEEK clinical performance as well as in the areas of materials science, tribology, and biology to provide a complete reference for specialists in the field of ... If deviation is present in the frontal or coronal plane in addition to claw toe, the loose collateral ligament side can be imbricated instead of released. Chicago, IL: ACFAS; March/April 2009. These investigators examined if surgical intervention with percutaneous K-wire fixation versus commercial intramedullary implant is more cost effective for PIP joint arthrodesis in hammertoe surgery. ) toe joint. Treatment is initially directed at relieving the pressure points. The potential advantages of this prosthesis include elimination of wire migration and breakage, enhanced control and stability of the digit, elimination of potential pin tract infection, and decreased patient anxiety since hardware removal is not required. In a case-series study (3 patients and a total of 7 toes), these researchers described an alternative method of hammertoe fixation using a permanently implanted, 1-piece intramedullary device used to stabilize the proximal inter-phalangeal interface. No statistically significant differences in functional outcome and incidence of complications were observed among the 3 fixation groups, although the 2 intramedullary implants were associated with greater fusion rates and patient satisfaction. }. Arthroplasty of the fifth toe cpt code? #closethis { Oliver TP, Armstrong DG, Harkless LB, Krych SM. Van Wyngarden TM. Toe Arthroplasty. Arthrodesis or arthroplasty of the proximal interphalangeal joint using temporary Kirschner wire fixation is the most widespread method of surgical stabilization. IS THE CARTIVA ® SYNTHETIC CARTILAGE IMPLANT (SCI) RIGHT FOR ME? Lehman DE, Smith RW. 4 Milwaukee-area clinics & free insurance checks. Excision, fusion and repair of toes 44618008. Corporate pricing for courses and academies are available upon request (request a demo here!). 08/26/2021 Ann Plast Surg. Transfer of the flexor digitorum longus for the correction of lesser-toe deformities. Correction of hammer toe surgery deformity by Z-plasty and bone graft. Emphasis is placed on the deforming role of the collateral ligaments and intrinsic tendons. Myerson MS. Arthroplasty of the second toe. These investigators stated that for this reason, in-depth cost-benefit studies are needed to justify their use as a standard treatment. Mann RA, Mizel MS. Monarticular non-traumatic synovitis of the MTP joint: A new diagnosis? Twenty-five patients (86.21 %) stated that they had no symptoms in the involved toes after surgery, and 4 (13.8 %) experienced occasional pain, 2 (6.9 %) of whom reported limitations of recreational activities and 2 (6.9 %) reported persistent swelling without activity limitations. 1998;19:137-143.
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