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CLAW TOES FULL
A relative rest period of 6 weeks was advised but full weight bearing was permitted during this time with the use of appropriate protective footwear. Appropriate dressings were applied and the foot covered with cotton wool and crepe bandage. The wound was then closed with interrupted nylon sutures. The MTP joint and the IP joints were held in the neutral position and a moderate amount of tension was applied to the transferred tendon before suturing it. The FDL tendon was then pulled below the dorsal expansion, brought out medially and sutured onto the extensor tendon and to itself. The Flexor digitorum longus (FDL) tendon was hooked out and cut as distally as possible. This ‘modification’ of the Taylor's procedure, possibly saved time taken for the surgery. The Flexor digitorum superficialis (FDS) tendon was identified and the two slips divided but were not sutured to the extensor tendon. Through a mid-lateral incision the flexor retinaculum was identified and opened longitudinally. A total of 27 toes were treated in the nine patients.Ī modified Girdlestone–Taylor procedure was used to correct the toe deformities. All nine patients accepted the offer of treatment and were treated with the Girdlestone–Taylor procedure.
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These patients were offered the chance for surgical correction of the deformities as a solution to their pain and ulceration. There were nine patients on follow-up at this centre since 1996, who reported with complaints of deformities of the toes associated with pain and/or ulcers of the toes. 3, 4 However, we did not come across any paper that dealt with surgical correction of Claw Toes in Spinal Cord Injury. 2 We found information in the literature regarding the use of Girdlestone–Taylor procedure for the correction of Claw Toes in other conditions like poliomyelitis, myelodysplasia and crush injury of the foot. In an earlier study of persons with spinal cord injury (SCI), 10% were found to have claw toes. The proximal phalanx tends to subluxate in the dorsal direction which results in excessive pressure on the metatarsal head, giving rise to metatarsalgia.
CLAW TOES SKIN
1 The deformity often gives rise to a painful callus on the skin over the interphalengeal (IP) joints and on the tip of the toe. The modified Girdlestones–Taylor procedure for claw toe correction appears to be a safe and effective treatment for patients with SCI.Ī claw toe is defined as one with the metatarsophalengeal (MTP) joint in hyperextension and the proximal interphalengeal (PIP) joint and distal interphalengeal (DIP) joint in flexion. All our patients had good to excellent results, with over 70% of the toes having excellent results. The mean time from injury to surgery was 20.4 years and the mean time from surgery to last follow-up was 37.3 months.
CLAW TOES SERIES
The average age of our series of patients was 43.3 years. They were also asked to grade their satisfaction with the surgical outcome. After examination of their medical records, their toes were assessed for pain, residual deformity and stiffness. Nine patients with claw toe deformities to 27 toes were treated at the PRSIC from 1996 to 2005. Princess Royal Spinal Injuries Centre (PRSIC), Northern General Hospital, Sheffield, UK. To evaluate the effectiveness of the modified Girdlestones–Taylor procedure in patients with spinal cord injury (SCI). A combination of review of case notes and outpatient follow-up.