Valgus Second Toe Deformity Treated With a Percutaneous Extracapsular Closing-Wedge Osteotomy of the Proximal Phalanx

Abstract

Background:

Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe.

Methods:

Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained.

Results:

Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees (P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence.

Conclusion:

Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction.

Level of Evidence:

Level IV, retrospective case series

Keywords

percutaneous surgery proximal phalanx osteotomy valgus second toe hallux valgus minimally invasive surgery

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References

Bouché

Heit

. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. J Foot Ankle Surg. 2008;47(2):125-137.

Brogan

Lindisfarne

Akehurst

Farook

Shrier

Palmer

. Minimally invasive and open distal chevron osteotomy for mild to moderate hallux valgus. Foot Ankle Int. 2016;37(11):1197-1204.

Coughlin

. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br. 2000;82(6):781-790.

Davis

Hodges Davis

Anderson

Thompson

Hamilton

. Proximal phalanx basilar osteotomy for resistant angulation of the lesser toes. Foot Ankle Int. 1997; 18(2):103-104. doi:10.1177/107110079701800213

Highlander

VonHerbulis

Gonzalez

Britt

Buchman

. Complications of the Weil osteotomy. Foot Ankle Spec. 2011;4(3):165-170.

Hobizal

Wukich

Manway

. Extensor digitorum brevis transfer technique to correct multiplanar deformity of the lesser digits. Foot Ankle Spec. 2016;9(3):252-257.

Holme

Sivaloganathan

Patel

Kunasingam

. Third-generation minimally invasive chevron akin osteotomy for hallux valgus. Foot Ankle Int. 2020;41(1):50-56.

Kilmartin

O’Kane

. Correction of valgus second toe by closing wedge osteotomy of the proximal phalanx. Foot Ankle Int. 2007;28(12):1260-1264.

Klinge

McClure

Fellars

DiGiovanni

. Modification of the Weil/Maceira metatarsal osteotomy for coronal plane malalignment during crossover toe correction: case series. Foot Ankle Int. 2014;35(6):584-591.

10.

Lewis

Ray

Miller

Gordon

. Third-generation minimally invasive chevron and akin osteotomies (MICA) in hallux valgus surgery: two-year follow-up of 292 cases. J Bone Joint Surg Am. 2021;103(13):1203-1211.

11.

Lewis

Ray

Robinson

, et al. Percutaneous chevron and akin (PECA) osteotomies for severe hallux valgus deformity with mean 3-year follow-up. Foot Ankle Int. 2021;42(10): 1231-1240.

12.

Mikhail

Markowitz

Di Lenarda

Guzman

Vulcano

. Clinical and radiographic outcomes of percutaneous chevron-Akin osteotomies for the correction of hallux valgus deformity. Foot Ankle Int. 2022;43(1):32-41.

13.

Myerson

Jung

. The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. Foot Ankle Int. 2005;26(9):675-679.

14.

Neufeld

Dean

Hussaini

. Outcomes and surgical strategies of minimally invasive chevron/akin procedures. Foot Ankle Int. 2021;42(6):676-688.

15.

Nickisch

Davis

. Basilar proximal phalangeal osteotomy (Akinette) for recalcitrant lesser-toe horizontal plane deformities. Tech Foot Ankle Surg. 2008;7(1):41.

16.

Polyzois

Mpeltsios

Dagas

Samelis

Polyzois

. Hallux valgus associated with valgus deformity of the lesser toes. In: Orthopaedic Proceedings. Vol 85-B, suppl 3. The British Editorial Society of Bone & Joint Surgery; 2003:227-227.

17.

Stainsby

. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl. 1997;79(1):58-68.

18.

Virtanen

Gommers

Oliphant

, et al. SciPy 1.0: fundamental algorithms for scientific computing in Python. Nat Methods. 2020;17(3):261-272.

19.

von Elm

Altman

Egger

, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808.

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