Operative report Claw Toe
Operative report 1
Preoperative Diagnosis
Rigid claw toe deformity of the right second toe with metatarsophalangeal joint contracture.
Postoperative Diagnosis
Same.
Procedure Performed
Correction of claw toe deformity by metatarsophalangeal joint capsulotomy, right second toe.
Indication
The patient presented with a painful claw toe deformity of the right second toe associated with metatarsophalangeal joint contracture, dorsal subluxation, difficulty with shoe wear, and failure of conservative treatment including shoe modifications, padding, splinting, and orthotics. Surgical correction by metatarsophalangeal joint capsular release was recommended after discussing the risks, benefits, and alternatives.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a digital block was administered. A well-padded ankle tourniquet was applied. The right foot was prepped and draped in the usual sterile fashion. Following exsanguination, the tourniquet was inflated and a surgical time-out was performed.
A longitudinal dorsal incision approximately 3 cm in length was made directly over the second metatarsophalangeal joint. Sharp dissection was carried through the subcutaneous tissues while carefully protecting the dorsal digital nerves and vessels. Hemostasis was maintained with electrocautery.
The extensor tendon was identified and gently retracted to expose the metatarsophalangeal joint capsule. A longitudinal dorsal capsulotomy was performed using a #15 blade. The medial and lateral capsular attachments were released, followed by release of the contracted collateral ligaments as necessary to mobilize the joint. Fibrotic capsular tissue and periarticular adhesions were carefully released until the metatarsophalangeal joint could be reduced into anatomic alignment without residual dorsal contracture.
Passive range of motion demonstrated satisfactory correction of the metatarsophalangeal joint alignment with restoration of joint mobility. Fluoroscopic imaging confirmed concentric reduction of the joint and appropriate alignment of the toe.
The operative field was irrigated thoroughly with sterile normal saline. Meticulous hemostasis was achieved. The subcutaneous tissues were approximated with interrupted absorbable sutures, and the skin was closed with interrupted nylon sutures.
The tourniquet was released with immediate capillary refill noted in the operative toe. Sterile Xeroform, gauze, and a compressive forefoot dressing were applied, followed by placement into a postoperative surgical shoe.
The patient tolerated the procedure well without complications and was transferred to the recovery room in stable condition.
Findings
Rigid claw toe deformity with dorsal contracture of the second metatarsophalangeal joint and capsular fibrosis. Excellent correction was achieved following metatarsophalangeal joint capsular release.
Implants : None.
Check your answer
28270 – Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint.
Operative report 2
Preoperative Diagnosis
Rigid claw toe deformity of the right second toe with proximal interphalangeal joint contracture.
Postoperative Diagnosis
Same.
Procedure Performed
Correction of claw toe deformity by proximal interphalangeal (IP) joint capsulotomy, right second toe.
Indication
The patient presented with a painful rigid claw toe deformity involving the proximal interphalangeal joint of the right second toe. The patient complained of chronic pain, dorsal corn formation, difficulty with shoe wear, and progressive limitation of toe motion despite conservative management including accommodative footwear, padding, splinting, and orthotics. Surgical capsular release of the interphalangeal joint was recommended after discussing the risks, benefits, and alternatives.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a digital nerve block was administered. A well-padded ankle tourniquet was applied. The right foot was prepped and draped in the standard sterile fashion. Following exsanguination with an Esmarch bandage, the tourniquet was inflated, and a surgical time-out was performed.
A longitudinal dorsal incision approximately 2.5 cm in length was made directly over the proximal interphalangeal joint of the second toe. Sharp dissection was carried through the subcutaneous tissue while carefully protecting the medial and lateral digital neurovascular bundles. Hemostasis was maintained with bipolar electrocautery.
The extensor tendon was identified and retracted to expose the proximal interphalangeal joint capsule. A longitudinal capsulotomy was performed over the joint. The medial and lateral collateral ligaments were sequentially released to free the contracted joint. Dense fibrotic capsular tissue and periarticular adhesions were sharply released using a #15 blade and tenotomy scissors until the joint was fully mobilized.
The proximal interphalangeal joint was gently manipulated through flexion and extension. Satisfactory correction of the flexion contracture and restoration of passive joint motion were achieved without the need for bony resection or arthrodesis. Clinical examination confirmed improved toe alignment and elimination of the fixed contracture. Fluoroscopic imaging demonstrated satisfactory alignment of the interphalangeal joint without osseous abnormality.
The operative field was irrigated thoroughly with sterile normal saline, and meticulous hemostasis was obtained. The extensor tendon was allowed to return to its anatomic position. The subcutaneous tissue was closed with interrupted 4-0 absorbable sutures, and the skin was closed with interrupted 4-0 nylon sutures.
The tourniquet was released with immediate capillary refill to the toe. Sterile Xeroform, gauze, and a compressive dressing were applied, followed by placement of the foot into a postoperative surgical shoe.
The patient tolerated the procedure well without complications and was transferred to the recovery room in stable condition.
Findings
Rigid claw toe deformity with marked capsular contracture and fibrosis of the proximal interphalangeal joint. The deformity was successfully corrected with isolated interphalangeal joint capsular release, restoring satisfactory passive alignment and motion.
Implants : None.
Check your answer
28272 – Capsulotomy; interphalangeal joint, each joint.
Operative report 3
Preoperative Diagnosis
Flexible claw toe deformity of the right second toe with extensor tendon contracture.
Postoperative Diagnosis
Same.
Procedure Performed
Correction of claw toe deformity by extensor tendon lengthening, right second toe.
Indication
The patient presented with a symptomatic flexible claw toe deformity of the right second toe causing dorsal toe pain, shoe irritation, and difficulty with ambulation. Physical examination demonstrated a flexible deformity primarily caused by extensor tendon contracture without significant fixed osseous deformity. Conservative treatment, including accommodative footwear, toe splints, padding, and orthotics, failed to provide adequate symptom relief. Surgical correction with extensor tendon lengthening was recommended after discussing the risks, benefits, and alternatives.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a digital nerve block was administered. A well-padded ankle tourniquet was applied. The right foot was prepped and draped in the standard sterile fashion. Following exsanguination with an Esmarch bandage, the tourniquet was inflated, and a formal surgical time-out was performed.
A longitudinal dorsal incision approximately 3 cm in length was made over the second metatarsophalangeal joint and proximal aspect of the toe. Sharp dissection was carried through the subcutaneous tissues while carefully protecting the dorsal digital neurovascular structures. Hemostasis was maintained with bipolar electrocautery.
The extensor digitorum longus tendon was identified and isolated. The surrounding adhesions were released, allowing full visualization of the tendon. A Z-lengthening of the extensor tendon was performed in a controlled fashion. The toe was gently plantarflexed to achieve the desired tendon length while correcting the dorsal contracture.
The tendon was repaired at the appropriate length using interrupted 3-0 nonabsorbable sutures, maintaining physiologic tension. Passive range of motion demonstrated restoration of balanced toe alignment with correction of the claw toe deformity and elimination of excessive extension. The tendon repair remained stable throughout flexion and extension testing.
The operative field was irrigated thoroughly with sterile normal saline. Meticulous hemostasis was achieved. The subcutaneous tissues were approximated with interrupted 4-0 absorbable sutures, and the skin was closed with interrupted 4-0 nylon sutures.
The tourniquet was released with immediate capillary refill noted in the operative toe. Sterile Xeroform, gauze, and a compressive dressing were applied. The toe was maintained in corrected alignment with a soft splint, and a postoperative surgical shoe was placed.
The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.
Findings
Flexible claw toe deformity of the second toe secondary to extensor tendon contracture without fixed bony deformity. Excellent correction was achieved following extensor tendon lengthening with restoration of balanced toe alignment.
Implants : None.
Check your answer
28313
Operative report 4
Preoperative Diagnosis
Flexible claw toe deformity of the right great toe secondary to extensor hallucis longus tendon imbalance.
Postoperative Diagnosis
Same.
Procedure Performed
Correction of claw toe deformity of the right great toe by extensor hallucis longus tendon transfer.
Indication
The patient presented with a symptomatic flexible claw toe deformity of the right hallux associated with dorsiflexion contracture, shoe irritation, pain during ambulation, and failure of conservative treatment including accommodative footwear, orthotics, splinting, and activity modification. Examination demonstrated a flexible deformity caused by extensor hallucis longus overpull without fixed osseous contracture. Surgical tendon transfer was recommended after discussing the risks, benefits, and alternatives.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a regional ankle block was administered. A well-padded ankle tourniquet was applied. The right lower extremity was prepped and draped in the standard sterile fashion. Following exsanguination with an Esmarch bandage, the tourniquet was inflated, and a formal surgical time-out was performed.
A longitudinal dorsal incision was made over the first metatarsophalangeal joint and extended proximally to identify the extensor hallucis longus tendon. Sharp dissection was carried through the subcutaneous tissues while protecting the dorsal cutaneous nerve branches and surrounding soft tissues. Hemostasis was maintained with bipolar electrocautery.
The extensor hallucis longus tendon was identified, isolated, and mobilized. Adhesions surrounding the tendon were carefully released to allow free excursion. The tendon was detached distally at its insertion while preserving adequate tendon length.
A second incision was made over the proximal phalanx of the hallux. A subcutaneous tunnel was created connecting the two incisions, and the extensor hallucis longus tendon was passed through the tunnel to its new insertion site.
A transverse drill hole was created through the base of the proximal phalanx. The tendon was passed through the osseous tunnel and secured under appropriate physiologic tension using nonabsorbable sutures with the hallux maintained in neutral alignment. The fixation was reinforced with additional interrupted sutures.
The hallux was taken through passive flexion and extension. The tendon transfer remained stable throughout the range of motion, with elimination of the claw deformity and restoration of balanced toe posture. Clinical examination confirmed satisfactory correction without residual dorsiflexion contracture or rotational deformity.
The operative field was irrigated thoroughly with sterile normal saline solution, and meticulous hemostasis was obtained. The subcutaneous tissues were closed with interrupted 3-0 absorbable sutures, and the skin was closed with interrupted 4-0 nylon sutures.
The tourniquet was released with immediate capillary refill and satisfactory perfusion of the hallux. Sterile Xeroform, gauze, and a compressive dressing were applied. The hallux was maintained in corrected alignment with a postoperative splint, and a postoperative surgical shoe was applied.
The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.
Findings
Flexible claw toe deformity of the hallux caused by extensor hallucis longus tendon imbalance without fixed osseous deformity. Successful correction was achieved with extensor hallucis longus tendon transfer, restoring balanced alignment and tendon function.
Implants
None.
Check your answer
28313
Operative report 5
Preoperative Diagnosis
Rigid claw toe deformity of the right second toe with painful prominence of the proximal phalanx.
Postoperative Diagnosis
Same.
Procedure Performed
Partial excision (partial phalangectomy) of the proximal phalanx, right second toe, for correction of claw toe deformity.
Indication
The patient presented with a rigid claw toe deformity of the right second toe associated with chronic pain, dorsal shoe irritation, recurrent corn formation, and difficulty with ambulation. Conservative treatment including accommodative footwear, toe padding, splinting, and orthotics failed to provide adequate relief. The deformity was primarily caused by a painful bony prominence of the proximal phalanx. Surgical correction by partial excision of the involved phalanx was recommended. The risks, benefits, and alternatives were discussed, and informed consent was obtained.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a digital nerve block was administered. A well-padded ankle tourniquet was applied. The right foot was prepped and draped in the standard sterile fashion. Following exsanguination with an Esmarch bandage, the tourniquet was inflated, and a formal surgical time-out was performed.
A longitudinal dorsal incision measuring approximately 3 cm was made over the proximal interphalangeal joint of the second toe. Sharp dissection was carried through the subcutaneous tissues while carefully protecting the medial and lateral digital neurovascular bundles. Hemostasis was maintained with bipolar electrocautery.
The extensor tendon was identified and split longitudinally to expose the proximal phalanx. The periosteum was elevated, providing full visualization of the head and neck of the proximal phalanx.
Using a small oscillating sagittal saw, the prominent distal portion of the proximal phalanx was partially excised. Residual irregular cortical bone was removed with a rongeur, and the remaining bone was contoured with a rasp until a smooth surface was obtained. Care was taken to preserve adequate bone stock and maintain stability of the toe.
Following bone resection, the toe was gently manipulated into corrected alignment. The claw deformity was significantly improved without residual bony impingement. The operative site was inspected, and no remaining osseous prominence was identified.
The wound was irrigated thoroughly with copious sterile normal saline solution, and meticulous hemostasis was achieved. The extensor tendon was repaired with interrupted absorbable sutures. The subcutaneous tissue was closed with interrupted 4-0 absorbable sutures, and the skin was closed with interrupted 4-0 nylon sutures.
The tourniquet was released with immediate capillary refill to the operative toe. Sterile Xeroform, gauze, and a compressive dressing were applied. The toe was maintained in corrected alignment, and a postoperative surgical shoe was placed.
The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.
Findings
Rigid claw toe deformity of the second toe with a prominent distal proximal phalanx contributing to the deformity and shoe irritation. Successful correction was achieved following partial excision of the involved phalanx with restoration of satisfactory toe alignment.
Specimens
Partial proximal phalanx bone (discarded unless otherwise requested).
Implants - None.
Check your answer
This report supports CPT 28124 only when the primary surgical work is partial excision of the phalanx. If the procedure instead includes PIP arthrodesis or resection arthroplasty to correct the claw toe, CPT 28285 is generally the more appropriate code, and 28124 should not be reported separately because the bone resection is integral to that procedure.
Operative report 6
Preoperative Diagnosis
Rigid claw toe deformity of the right second toe.
Postoperative Diagnosis
Same
Procedure Performed
Correction of rigid claw toe deformity by proximal interphalangeal (PIP) joint arthrodesis, right second toe.
Indication
The patient presented with a painful rigid claw toe deformity of the right second toe causing chronic dorsal corn formation, shoe irritation, difficulty with ambulation, and fixed flexion contracture of the proximal interphalangeal joint despite prolonged conservative treatment including accommodative footwear, toe splints, padding, and orthotics. Surgical correction with PIP joint arthrodesis was recommended after discussing the risks, benefits, and alternatives.
Description of the Procedure
The patient was brought to the operating room and placed in the supine position. Monitored anesthesia care with a digital nerve block was administered. A well-padded ankle tourniquet was applied. The right foot was prepped and draped in the usual sterile fashion. Following exsanguination with an Esmarch bandage, the tourniquet was inflated, and a formal surgical time-out was performed.
A longitudinal dorsal incision approximately 3 cm in length was made directly over the proximal interphalangeal joint of the second toe. Sharp dissection was carried through the subcutaneous tissue while protecting the medial and lateral digital neurovascular bundles. Hemostasis was maintained with bipolar electrocautery.
The extensor tendon was identified and split longitudinally in line with its fibers. The tendon was elevated to expose the proximal interphalangeal joint capsule. A longitudinal capsulotomy was performed, and the collateral ligaments were released from both sides to fully expose the joint.
The head of the proximal phalanx was resected using an oscillating sagittal saw. The remaining cortical margins were contoured with a rongeur. Residual articular cartilage from the base of the middle phalanx was removed with a curette until healthy cancellous bone was exposed. Multiple small drill holes were created across both fusion surfaces to promote osseous healing.
The toe was positioned in neutral alignment with correction of the claw toe deformity. A 0.045-inch Kirschner wire was inserted in an antegrade fashion through the middle and distal phalanges and then advanced retrograde across the prepared proximal interphalangeal joint into the proximal phalanx, maintaining the arthrodesis in the desired position.
Clinical examination confirmed satisfactory correction without rotational deformity. Fluoroscopic imaging demonstrated appropriate alignment of the toe, satisfactory preparation of the fusion surfaces, and proper Kirschner wire placement.
The operative site was irrigated thoroughly with sterile normal saline, and meticulous hemostasis was achieved. The extensor tendon was repaired with interrupted absorbable sutures. The subcutaneous tissue was closed with interrupted absorbable sutures, and the skin was closed with interrupted nylon sutures.
The Kirschner wire was cut, bent, and protected with a sterile pin cap. The tourniquet was released with immediate capillary refill noted in the operative toe. Sterile Xeroform, gauze, and a compressive dressing were applied, followed by placement into a postoperative surgical shoe.
The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.
Findings
Rigid claw toe deformity of the second toe with fixed proximal interphalangeal joint flexion contracture and degenerative articular changes. Excellent correction was achieved with stable proximal interphalangeal joint arthrodesis.
Implants
One 0.045-inch Kirschner wire.
Check your answer
28899
Comments