Hallux Interphalangeal Joint Arthrodesis and Jones Tendon Transfer

Abstract

Pathology of the hallux interphalangeal joint (HIPJ) may stem from a number of disorders. Neurological disease, such as Charcot-Marie-Tooth, can cause claw toe deformity that becomes progressively rigid over time. Rigid deformity is no longer amenable to soft tissue balancing procedures in later stages of the disease and will likely require arthrodesis of the HIPJ. Patients will present with pain in the hallux and sometimes ulceration at the tip of the hallux from increased pressure when weight-bearing or rubbing in shoe gear. As the claw toe deformity worsens, a hallux malleus deformity may occur in which the extensor hallucis longus (EHL) tendon contracts. This causes a retrograde force at the first metatarsophalangeal joint (MTPJ) in which the first metatarsal becomes plantarflexed which may eventually lead to ulceration under the metatarsal head. The combination of HIPJ arthrodesis with transfer of the extensor hallucis longus into the 1st metatarsal neck, also known as the Jones tendon transfer, is a predictable procedure with a relatively small learning curve that serves to alleviate pain, prevent ulceration, and restore the alignment of the distal first ray.