The Ruiz-Mora procedure: a surgical the cock-up deformity of the fifth toe treatment of

Summary A fixed rotational deformity of the fifth toe combined with subluxation/dislocation of the fifth metatarsophalangeal joint is also known as the cock-up deformity. If the toe cannot be accommodated by wide or extra-depth shoes surgery may be indicated. Surgical treatment requires adequate bony decompression. Complete excision of the proximal phalanx combined with tightened plantar skin closure after elliptical plantar skin excision, the Ruiz-Mora procedure, provides good relief of symptoms. We reviewed 18 patients with 22 procedures, operated on between 1986 and 1996. Two patients with two procedures had post-traumatic foot deformities and because of the different underlying aetiology and pathology of their deformity were excluded from the study. There were 10 women and eight men, and four patients had bilateral operations. The average age at surgery was 38 years. Follow-up examination was possible for 17 cases. These patients were followed for an average of 6.6 years. After surgery there was no recurrence of deformity. Subjectively, all of the examined patients had complete relief of pain. Three recurrences of a simultaneously surgically treated hammer toe deformity of the fourth toe with a corn on the dorsal aspect of this toe were observed. In two cases a floppy fifth toe, and in another two cases some problems with excessive shortening, were noted. The use of a partial syndactylization between the fourth and fifth toe or a skin incision placed near to interdigital space should be considered to avoid the excessive shortening and the development of a floppy fifth toe.