American Podiatric Medical Association

View all recommendations from this society

Released January 19, 2022

Avoid using expensive fixation in hammertoe surgery without first engaging in shared decision making to evaluate alternatives.

From an efficacy standpoint, there is no clear benefit to using commercially available hammertoe implants over conventional K-wire fixation, and the cost of commercial devices, when used routinely, may be prohibitive. Since some patients may prefer the idea of not having implantable hardware retained for life, while others may not want hardware exiting the toe during the immediate postoperative period, selection of hammertoe fixation represents an opportunity for shared decision making.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

(1–5) The American Podiatric Medical Association’s (APMA) Clinical Practice Advisory Committee, consisting of APMA members, board members, young members and liaisons with special interests in a variety of subspecialty areas within podiatric practice, formulated the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to eight recommendations. The list of eight recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation enabled the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.

(6–10) The American Podiatric Medical Association (APMA) tasked their Clinical Practice Advisory Committee consisting of APMA members, board members, young members, and liaisons with special interests in a variety of subspecialty areas within podiatric practice to formulate the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to nine recommendations. The list of nine recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation allowed the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.

APMA’s disclosure and conflict of interest policy can be found at www.apma.org.

Sources

Albright RH, Waverly B, Klein E, Weil L Jr., Weil LS Sr, Fleischer AE. Percutaneous Kirschner wire versus commercial implant for hammertoe repair: a cost-effectiveness analysis. J Foot Ankle Surg. 2018;57(2):332-8.

Albright RH, Hassan M, Randich J, O’Keefe R, Klein EE, Weil L Jr, Weil L Sr, Fleischer AE. Risk factors for failure in hammertoe surgery. Foot Ankle Int. 2020;41(5):562-71.

Kramer WC, Parman M, Marks RM. Hammertoe correction with K-wire fixation. Foot Ankle Int. 2015;36(5):494-502.