Use of Smart Toe© implant for small toe arthrodesis: A smart concept?

• Small toe arthrodesis is a common forefoot surgical procedure.
• k-wires can migrate, break and lack compression and control of rotation.
• Smart Toe© is an intramedullary memory monobloc nickel and titanium alloy implant.
• It provided stable fixation with compression, few complications and 96.3% union rate.
• We had good clinical and radiological outcome and patient acceptance.

BackgroundArthrodesis of small joints for hammer and claw toe deformities is a common forefoot operative procedure. Our objective was to review patients who underwent small toe arthrodesis with Smart Toe© intramedullary monobloc implant. Our aim was to assess patient's surgical outcome and to ascertain implant suitability.MethodsThis procedure was undertaken in 90 patients from February 2011 to December 2012. We present our review of 82 (91.1%) patients who attended the final six 6-month follow up. Mean age was 56.5 years. There were 7 (8.5%) males and 75 (8.5%) males and 75 (91.5%) females. Clinical and radiological evaluation was undertaken. A questionnaire was used to assess general symptoms, clinical outlook, deformity and patient's perceptions and acceptance. Foot and Ankle Outcome Score and Foot and Ankle Disability Index were used to judge outcome.ResultsThere were 71 (86.6%) proximal and 11 (13.4%) distal interphalangeal joints with 69 (84.1%) second, 7 (8.5%) third, 6 (84.1%) second, 7 (8.5%) third, 6 (7.3%) fourth toes. There was persistent swelling in 7 (8.5%) and tenderness in 1 (1.2%). Appearance of toes was symmetrical in 71 (86.6%) and 11 (13.4%) were asymmetrical but asymptomatic. The mean range of movement of the adjacent joint was 53.9°. Control of toes was good in 72 (87.8%) patients. Mean percentage of improvement was 76.1% with 100% in 17 (20.7%) and over 80% in 47 (57.3%). Seventy (85.3%) would recommend and undergo repeat surgery. There were 2 (2.4%) cases of metal cut out. There was one (1.2%) implant failure. Union was achieved in 79 (96.3%) patients.ConclusionWe feel that Smart Toe© small toe arthrodesis is a safe and reliable technique with good patient outcome and acceptance.