Percutaneous correction of second toe proximal deformity: Proximal interphalangeal release, flexor digitorum brevis tenotomy and proximal phalanx osteotomy

Abstract

We report the results of a percutaneous technique to correct a proximal plantar flexion deformity of the second toe that combines several procedures: tenotomy of the Flexor Digitorum Brevis, plantar capsulotomy for release of the proximal interphalangeal joint and proximal phalangeal osteotomy. The goal of these procedures is to improve anatomical correction and preserve articular range of motion. From 2009 to 2011, 54 patients, mean age 64.4 years old (43-81) underwent surgery for a proximal deformity of the second toe. Associated tenotomy of the extensor digitorum longus and brevis was performed in the presence of an extension deformity of the metatarsophalangeal joint (24 cases). After a mean follow-up of 30.7 ± 8.9 months, the rate of satisfaction and morphological correction was high (89.5% in both cases), as well as the number of flexible toes (88%). Active plantar flexion was preserved in 86% of the cases. This seems to be an effective technique to correct proximal plantar flexion deformity of the second toe, while preserving active plantar flexion.

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

“…The treatments of lesser toes deformities by MIS are mostly based on soft tissue release, such as joint capsulotomies and tenotomies. The procedures on the bone depend on the residual deformities, the reducibility, and the toe length [11, 19, 20]. Some authors use complete osteotomies for the correction of digital deformities [21, 22], others perform unicortical osteotomies in certain pathologies [16, 23], but all of them follow the same protocol starting correction with soft tissue techniques.…”

Rheumatoid Forefoot Reconstruction Following Minimally Invasive Surgery and Hoffmann-Clayton Procedure with Administration of Plasma Rich in Growth Factors - A 3-Year Follow-Up: A Retrospective Study

“…This selective tenotomy sustains the grasping function of the toes. In the year 2015, a paper published by Frey et al (20) reported their results from a series of 57 feet presenting an isolated second toe PIPJ deformity without metatarsalgia or DIP deformity treated with a selective FDB tenotomy, plantar PIPJ release, and P1 osteotomy. In 42% of cases, extensor tenotomy was the choice.…”

“…Eighty-six percent of the lesser rays had retained active plantar flexion compared to 74% of the lesser rays who were semi-rigid or rigid before the surgery. A revision was reported only in 2 cases (3.5%) in which PIPJ fusion was carried out (20).…”

Dressing Techniques in Percutaneous Toe Surgery

“…Percutaneous toe corrections are a combination of small gestures including soft tissue procedures and osteotomies. 3,[12][13][14][15] The soft tissue procedures consist of detachments of tendons from the bone, tenotomies, and capsulotomies. Osteotomies can be performed in different directions.…”

“…The most common are hallux valgus, bunionette, metatarsalgia, and toe deformities. Percutaneous toe corrections are a combination of small gestures including soft tissue procedures and osteotomies 3,12–15. The soft tissue procedures consist of detachments of tendons from the bone, tenotomies, and capsulotomies.…”