Modified Jones procedure for post-polio claw hallux deformity.

Abstract

A prospective study was carried out on 12 patients with postpoliomyelitis clawing of the hallux treated by a modified Jones procedure using Kirschner wire for the interphalangeal joint fusion. The purpose of this study was to evaluate the outcome of a modified Jones procedure in the treatment of postpolio claw hallux deformity. All the patients had symptoms related to the claw hallux deformity; foot biomechanics and gait were affected. Patients were assessed both pre- and postoperatively using Axer's criteria. Mean follow-up was 32 months. Ten patients had very good results and two patients had fair results. The transferred extensor hallucis longus became loose in two patients who had a coexistent tight Achilles tendon. Recurrence of medial cavus deformity occurred 3 months after the operation in both of these patients. This was treated by shortening the transferred extensor hallucis longus after elongating the tight Achilles tendon. No pseudoarthrosis of the interphalangeal joint was identified. When the Jones procedure is performed, the motor power of the extensor hallucis longus should be Medical Research Council Grade V before transfer. The Achilles tendon should be evaluated for equinus preoperatively and lengthened when equinus deformity is present in order to avoid residual foot deformities.