Kadel Nancy J, Donaldson-Fletcher Emily A, Hansen Sigvard T, Sangeorzan Bruce J
University of Washington, Orthopaedics and Sports Medicine, 1959 NE Pacific St., Box 356500, Seattle, WA 98195, USA.
Foot Ankle Int. 2005 Dec;26(12):1021-6. doi: 10.1177/107110070502601204.
The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by overpull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third.
We retrospectively identified 19 patients (22 feet) who had FHL tendon transfer for correction of clawed hallux over a period of 5 years. Followup was an average of 51.0 (range 6 to 74; +/- 3.8) months after the procedure. Outcome and patient satisfaction were determined using the Long-Form Musculoskeletal Function Assessment (MFA) score. Patients were asked whether they were satisfied, somewhat satisfied, or dissatisfied with the overall outcome and were asked about shoewear limitations. Preoperative and postoperative radiographs were evaluated in 15 patients (17 feet). We measured the hallux valgus and interphalangeal (IP) angles on the anteroposterior (AP) radiographs. On the lateral view we measured the angle of the IP joint, the metatarsophalangeal (MTP) joint, and the talometatarsal angle. Statistical analysis was done using a repeated measures ANOVA (p < 0.05).
On the lateral radiographs, the hallux IP joint angle (p < 0.0012; n = 15) and hallux MTP joint angle (p < 0.0265; n = 15) were significantly reduced postoperatively. On AP radiographs, the hallux valgus angle (p < 0.0334) was significantly reduced; however, the IP angle and the talometatarsal angle were not significantly different after surgery. Patients had an average MFA score of 14.6 (+/-3.8 standard error, range 1 to 35; n = 19). Thirteen patients were fully satisfied and six were somewhat satisfied with the overall result of the surgery. Four patients thought that their hallux limited the types of shoes they could wear, while 15 did not.
It has been shown that clawed hallux can result from excessive motor function in one of three muscles: FHL tendon, peroneus longus (PL), and extensor hallucis longus (EHL). This study suggests that transfer of part of the tendon of the FHL is an effective alternative operative procedure for correction of clawed hallux.
改良琼斯手术是矫正拇趾爪形畸形的传统手术方法，尽管这种畸形可能由三种不同肌肉之一的过度牵拉引起。在本研究中，我们展示了拇长屈肌腱（FHL）转位治疗拇趾爪形畸形的影像学和功能结果。转位操作是将FHL肌腱的三分之二向上穿过近节趾骨的钻孔，然后在内侧将其缝合回剩余的三分之一。
我们回顾性确定了19例患者（22足），他们在5年期间接受了FHL肌腱转位以矫正拇趾爪形畸形。术后平均随访51.0（范围6至74；±3.8）个月。使用长格式肌肉骨骼功能评估（MFA）评分来确定结果和患者满意度。询问患者对总体结果是满意、有点满意还是不满意，并询问鞋类限制情况。对15例患者（17足）的术前和术后X线片进行了评估。我们在前后位（AP）X线片上测量拇外翻和趾间（IP）角。在侧位片上，我们测量IP关节、跖趾（MTP）关节和距跖角。使用重复测量方差分析进行统计分析（p < 0.05）。
在侧位X线片上，术后拇趾IP关节角（p < 0.0012；n = 15）和拇趾MTP关节角（p < 0.0265；n = 15）显著减小。在AP X线片上，拇外翻角（p < 0.0334）显著减小；然而，术后IP角和距跖角无显著差异。患者的平均MFA评分为14.6（±3.8标准误，范围1至35；n = 19）。13例患者对手术的总体结果完全满意，6例有点满意。4例患者认为他们的拇趾限制了他们能穿的鞋的类型，而15例患者则没有。
已表明拇趾爪形畸形可由三种肌肉之一的运动功能亢进引起：FHL肌腱、腓骨长肌（PL）和拇长伸肌（EHL）。本研究表明，FHL肌腱部分转位是矫正拇趾爪形畸形的一种有效的替代手术方法。
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