The lesser toe PIP joints are the primary deformity sites for hammertoe (fixed PIP flexion contracture) and are the joints addressed surgically in toe deformity correction. Hammertoe results from intrinsic muscle imbalance allowing the long extensor to hyperextend the MTP joint while the FDL flexes the PIP joint, producing a fixed flexion deformity that causes a painful dorsal corn from shoe friction.
PIP joint arthrodesis (fusion) in the corrected position eliminates the hammertoe deformity permanently and is the preferred surgical treatment for rigid hammertoes. PIP arthroplasty (implant or resection) is used for flexible deformities. The joint is approached dorsally via a skin ellipse over the corn, with the collateral ligaments divided and the joint surfaces resected for fusion.
Fixed PIP flexion contracture from intrinsic muscle imbalance producing dorsal corn and toe pain managed with PIP joint arthrodesis.
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