• hammer toe causing dorsal heloma durum or recurrent ulceration that does not respond to conservative care
• multiple digital deformities

• Longitudinal midline incision of 2.5-3.0 cm on dorsum of toe is made
• incision deepened
• identify and coagulated vessels
• separate superficial fascia from deep fascia, extensor hood and joint capsule
• flex digit, then cut medial and collateral ligaments
• transverse transection of extensor tendon  retract
• dissect free head of proximal phalanx
Then (depends on preference of surgeon):

1) End to end arthrodesis:
• used if shortening of toe is a concern
• remove cartilaginous surfaces of joint to expose raw cancellous bone
• insert K-wire to fix position – remove after 4-6 weeks

2) Peg in hole arthrodesis:
• possibly more stable than end to end arthrodesis
• resect medial, lateral and plantar condyles of head of phalanx – shaped into a ‘peg’ with burr
• use burr to create hole in base of distal phalanx
• insert proximal phalanx into distal

Long term complications:
• short toe

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