Flexor to Extensor Tendon Transfer (Girdlestone-Taylor)

What is a flexor to extensor tendon transfer?

This surgery is used to treat flexible hammertoe deformity. A hammertoe deformity is one in which the toe is bent and can appear like a hammer. A flexible deformity is one in which the toe can be manipulated into a straight position. This deformity can lead to difficulty with shoewear, corn formation and pain with walking.
This procedure can also be used to treat conditions in which the toe deviates or crosses over the remaining toes. Prior to considering surgery, a course of nonsurgical care should be attempted. Methods including shoewear modification, splinting and toe sleeves are possible conservative options for treatment.

What are the goals of a flexor to extensor tendon transfer?

The goals of the surgery are to improve the alignment of the toe, eliminate any prominences that can lead to corn formation and improve shoewear accommodation.

When should I avoid surgery?

Patients with a history of poor circulation and loss of feeling in the feet and toes are at higher risk of infection and should be counseled appropriately.

General Details of Procedure

The procedure is performed as an outpatient procedure, meaning that you can go home the same day. It can be performed with the patient awake with numbing medication injected into your foot or you can be asleep for the procedure. A tourniquet is applied to your foot to minimize blood loss.

Specific Technique

The technique involves making an incision on the bottom of the involved toe. There are two tendons to each toe that help to flex or bend the toe. One of the tendons is taken and shifted to the top of the toe. It is then attached to the tendon that extends or straightens the toe through an incision on the top of the toe. A pin may be inserted into the toe to help maintain alignment for a number of weeks after the procedure.

What happens after surgery?

Patients are typically allowed to ambulate after the procedure in a sandal. If other procedures are done simultaneously, this may restrict your ability to weight bear for a period of time after surgery. Sutures are generally removed at two weeks after surgery. The toe is also taped to help maintain alignment for several weeks. Patients can generally be allowed to return to regular shoewear in approximately four to six weeks after surgery. Swelling can also be expected within the toe which can persist for many months after surgery.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications from this procedure include stiffness and potential recurrence of the deformity.

Frequently Asked Questions

When can I return to work?
Return to work is variable and depends on the nature of your occupation. In general, return to a sedentary job can occur over a few days to two weeks. More physically demanding occupations will require a longer period of time to recover.
When will I be allowed to drive?
If the surgery involves the non-driving foot, you can return to drive within a few days of surgery. If it involves the driving foot, it may be several weeks before you can return to drive. It is important to discuss this with your physician prior to undergoing surgery.

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