Good day: I have done this procedure- amputation of a second digit in
instances where it was not reasonable to contemplate more extensive HAV
surgery due to medical and/or social issues. I have found it most useful
in relieving pressures which lead to ulceration- here, it is a good
trade off, especially in those unusual cases where the hallux over-rides
the second toe. Cosmetically, the hallux assumes the 2nd digit
"position" and at first glance the foot appears quite normal and
patients have been happy, though raising the suggestion requires some
tact......... Cheers. R Eckles DPM
-----Original Message-----
From: John Mason [mailto:[log in to unmask]]
Sent: Wednesday, March 17, 2004 1:26 PM
To: [log in to unmask]
Subject: Re: 2nd toe amputation[Scanned]
Hi,
No, amputation is not indicated for a 2nd hammer toe. An excisional
arthroplasty or in a very few cases
an arthrodesis would be indicated.
Amputation is indicated where the toe is severely dorsally subluxed or
dislocated at the mpt, and of course in such a case
there is no buttressing effect against the hallux. The subluxed toe may
or
may not be hammered.
A hammer toe is one thing, subluxation is another.
John Mason
----- Original Message -----
From: "Houghton, David" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 17, 2004 3:42 PM
Subject: 2nd toe amputation
> Hello all
>
> I would appreciate you comments re 2nd toe amputation for hammer toe
> deformity.
>
> The reason that I ask is that a Podiatric Surgeon was showing me pre
an
> post op pics of a total 2nd toe amputation, in an active patient, I
don't
> know their age, but approx in their 60's. His justification was that
> amputation is a more straightforward procedure, which I don't doubt.
>
> My argument was that with a Hallux Valgus ( which there was in the
pics) ,
> then the prox phalanx would provide a buttress to prevent lateral
hallux
> deviation. Perhaps I am mistaken in this assumption, and there is
still a
> place for this surgery.
>
> The only example that I can think of where this could possibly be the
> procedure of choice is in a patient who has limited mobility, and has
a
> screaming hammer toe, and 1st met ostotomy with 2nd toe arthrodesis
would
> be like using a sledgehammer to crack a nut.
>
> I have put these points to the Pod Surgeon, and he disagrees that any
> buttress effect is provided by the 2nd toe when dorsally displaced,
and
> therefore will continue to do the procedure, even in active patients.
>
> I am not a Pod Surgeon, so would appreciate some guidance about 2nd
toe
> procedures, and under which circumstances they are indicated.
>
> David Houghton
>
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