THE TREATMENT OF CLAW TOES BY MULTIPLE TRANSFERS OF FLEXOR INTO EXTENSOR TENDONS

This paper is an attempt to assess the value of transfer of the flexor into the extensor tendons of the toes in the treatment of claw toes. In the fully developed condition, with hyperextension of the metatarso-phalangeal joints and flexion of the interphalangeal joints, the long flexor tendons can no longer act as slings under the metatarsal heads, which become depressed. Painful callosities develop in relation to the new pressure areas, namely under the heads of the metatarsals and the tips of the toes, and over the dorsum of the proximal interphalangeal joints, from pressure against the shoe. The claw deformity deprives the interossei and the lumbricals of any function of flexing the toes at the metacarpo-phalangeal joints and all the strain of the push-off in walking now falls on the metatarsal heads. Indeed, once the deformity is established, the intrinsic muscles become adaptively shortened, and because the line of their action is now dorsal to the transverse axis of movement at the metatarso-phalangeal joints they act as extensors and perpetuate the deformity. For this reason the power of plantar-flexion of the metatarso-phalangeal joints, which is so essential for efficient function of the forefoot, is lost. Etiology-A common explanation for claw toes is paralysis of the intrinsic muscles of th