Flail Toe Correction: Interpositional Bone Graft and Syndactylization Approaches

Abstract

The flail toe or floppy toe deformity is a condition in which one or more toes of a foot lack stability and structural integrity as the result of excessive bone loss (from surgery, infection, trauma, or tumor) and/or gross motor instability from resection or overlengthening of the tendinous structures to the toe. Excessive resection of bone during the performance of a proximal interphalangeal joint arthroplasty is the most common etiology, but the actual rate of flail or floppy toe following the arthroplasty procedure has not been reported in the literature [1]. The flail or floppy toe deformity should be differentiated from a floating toe deformity or syndrome. McGlamry [2] defined “floating toe syndrome” as a condition in which one or more toes on a foot fail to purchase the weight-bearing surface of the ground during stance or gait. The floating toe deformity is typically at the level of the metatarsophalangeal joint and results from insufficient loading of the plantar plate during stance and gait. Floating toe deformity is commonly seen following shortening or elevating metatarsal osteotomies; following a plantar plate tear, with congenital brachymetatarsia; or following any condition that causes the flexor mechanism and plantar plate of a toe to function inadequately and improperly load during weight-bearing.