Abstract
Category:
Lesser Toes
Introduction/Purpose:
Lateral fifth toe corns (LFC) form as a result of extrinsic pressure from footwear. Interdigital corns (IDC) form over the condyles of the phalanx between the toes, and can be soft and very painful in most cases. When conservative treatment fails, surgical treatment is indicated. Partial condylectomy for interdigital cornsis difficult because of the narrow webspace and risk of painful postoperative scar. No prior study has been published on percutaneous surgery for lateral fifth toe and interdigital corns, with the exception of some publications on the explanation of the technique.
Methods:
We performed percutaneous partial condylectomy for six toes in five patients with one LFC and five IDCs. The mean age was 71 years. The mean follow-up period was 16.2 months. All feet, except for one malalignment case after second proximal phalanx fracture, had both hallux valgus and bunionette. A small incision was made distal to the corn to allow the insertion of the entire cutting surface of a burr to avoid skin damage. The periosteum was removed from the eminence by a small rasp and provided an adequate working area. The bone eminence was then removed with 2-5 or 2-8 mm burrs. For hallux valgus and proximal phalanx malalignment after fracture, we also corrected them percutaneously. In some cases, the Japanese Society for Surgery of the Foot (JSSF) lesser toes scales and self-administered foot evaluation questionnaire (SAFE-Q) were evaluated pre- and postoperatively.
Results:
There was no complication, except for one valgus deformity in the second proximal interphalangeal joint after partial condylectomy. At the final follow-up visit, all patients had no recurrence of corns and no symptoms, and were very satisfied with the results during the follow-up period of one year. In case of IDC, JSSF lesser toes scale improved from 45 points to 100 points at the final follow-up. All SAFE-Q subscores were improved with regard to 'Pain and pain-related' sensations from 36.7 to 99.6, 'Physical functioning and daily living' from 54.5 to 100, 'Social functioning' from 37.5 to 100, 'Shoe-related' from 25 to 100, and 'General health and well-being' from 25 to 95. The visual analog scale of pain improved from 7 to 0.4.
Conclusion:
The percutaneous procedure consisted of partial condylectomy with correction of associated deformities achieved good results without major complications and recurrence over the one year follow-up period.