Flexor to Extensor Transfer for Clawtoe Deformity Correction
Edited by Sam Dellenbaugh, MD
A flexor to extensor transfer will provide a dynamic correction to a claw toe deformity. It’s indicated for significant claw toe deformities that have failed non-operative treatment. The claw toe deformity develops as a result of muscle imbalance. This procedure is designed to address this type of muscle imbalance so that the correction of the deformity is maintained over time.
The flexor to extensor transfer can be performed in a couple of ways. An incision over the top aspect of the toe can be performed, and the dissection can be taken down the side of the toe so that the tendon that flexes the toe (Flexor Digitorum Longus) is identified on the underside of the toe. This tendon is then cut and transferred to the top of the toe at the base. As a result, this tendon will cause the base of the toe to be pulled down, rather than flexing the tip of the toe and increasing the claw toe deformity. This creates a more stable position for the toe. The tendon that is transferred is sutured into the extensor tendon.
This procedure may also be performed by harvesting the flexor tendon through a separate incision on the undersurface of toe. The tendon is then transferred up to the top of the toe, either through the PIP joint or along the side of the toe. It is again sutured into the associated sheath of the extensor tendon.
It’s important that the transferred tendon has sufficient time to heal. This requires limited loading and relative immobilization of the healing tendon for about 6 weeks after the surgery. During this time, it is usually protected with a screw or a pin.
Potential Surgical Complications
Complications that are relatively specific to a claw toe correction a Flexor to Extensor transfer (Girdlestone-Taylor procedure) include:
- Failure of the transfer tendon.
- Tendon is pulled out of the area that it was transferred in.
- Misalignment of the toe.
- Occasionally, the direction of the pull of the tendon can be such that the toe will move out of the desired alignment.
- Increased swelling.
- Increased pain.
- Vascular injury.
- Although uncommon, the blood vessels supplying the tip of the toe may be damaged, causing necrosis and occasionally loss of the tip of the toe.
In addition to the specific complications listed above, there is the potential for the following general complications:
- Wound healing problems
- Nerve injury
- Blood clots (Deep Vein Thrombosis / DVT) –uncommon in toe surgery
- Pulmonary embolism –uncommon in toe surgery
Edited on June 13, 2017
(Originally edited by Stephen Pinney, MD)