From the Guidelines
Hammertoe correction surgery does not directly contribute to stabilizing a nonunion in the midfoot, as these are distinct orthopedic issues requiring separate treatment approaches. The primary goal in managing a midfoot nonunion is to promote bone healing and stability, which is typically achieved through interventions such as bone grafting, internal fixation with screws or plates, or fusion procedures specifically targeting the affected midfoot bones 1.
Key Considerations
- Hammertoe correction primarily addresses deformities of the lesser toes, impacting forefoot mechanics rather than midfoot stability.
- While addressing hammertoe deformities might indirectly improve overall foot biomechanics and weight distribution, potentially reducing stress on the midfoot, this effect is not sufficient to stabilize an established nonunion.
- The treatment for a midfoot nonunion should be determined by an orthopedic foot and ankle specialist, typically involving surgical intervention specifically targeting the nonunion site with fixation and possibly bone grafting to promote healing and restore midfoot stability.
Clinical Evidence and Guidelines
The provided evidence focuses on the management of active Charcot neuro-osteoarthropathy (CNO) in persons with diabetes mellitus, emphasizing the importance of immobilization and offloading to prevent progressive deformity and promote healing 1. While this guidance does not directly address the relationship between hammertoe correction and midfoot nonunion stability, it underscores the principle of targeted intervention for specific foot and ankle pathologies.
Recommendations for Practice
- Midfoot nonunion treatment should prioritize interventions directly addressing the nonunion, such as bone grafting and internal fixation.
- Hammertoe correction, while beneficial for addressing forefoot deformities, is not a substitute for targeted treatment of midfoot nonunion.
- Clinical decision-making should be guided by the most recent and highest quality evidence, with consideration of individual patient factors and the expertise of an orthopedic foot and ankle specialist.
From the Research
Hammertoe Correction and Nonunion Midfoot Stabilization
- The provided studies do not directly address the relationship between hammertoe correction and stabilization of a nonunion midfoot.
- However, some studies discuss the management of nonunion and the correction of hammertoe deformity separately.
- For example, the study by 2 reviews the principles of nonunion management, including the diagnosis and treatment of nonunion, while the study by 3 discusses a surgical technique for correcting hammertoe deformity.
- The study by 4 evaluates the outcomes of operative treatment of nonunited rotational distal fibula and medial malleolar ankle fractures, but does not specifically address the midfoot.
- Other studies, such as 5 and 6, discuss various techniques for correcting hammertoe deformity, but do not address the stabilization of a nonunion midfoot.
- Therefore, based on the provided evidence, there is no direct information available to determine whether hammertoe correction helps stabilize a nonunion midfoot.