Correction of valgus lesser toe deformity using a closing wedge osteotomy of the proximal phalanx: percutaneous technique and 2 year results

R. Ray, T. Lewis, P.W Robinson, P.MC Dearden, T.AJ Goff, C. Watt, P. Lam

Introduction: Coronal 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 novel percutaneous closing wedge unfixed osteotomy of the proximal phalanx to treat valgus deformity of the 2^nd toe.

Methods: 31 patients underwent 40 percutaneous osteotomies at a mean age of 58.3±9.4 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy of the second toe (± other lesser toes if indicated) is performed leaving the dorsolateral cortex intact. An irrigated low speed, high torque 2x8mm burr is used under image guidance. The toe is then kinked at the osteotomy site and taped for 2 weeks. Mean follow up was 2.0±1.5years.

Results: Questionnaire data was available for 89.7% (n=35) of cases. 91.4% of cases were satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies. Mean lesser toe valgus angle (LTVA) decreased from 17.3±10.7° to 6.5±7.0° (p<0.001) at final follow up. All osteotomies united with no delayed union. There were no wound complications or infections. There was no statistically significant change in LTVA between radiographs taken at 6 weeks and final follow up. There were 2 cases of radiographic recurrence.

Conclusion: Percutaneous proximal phalanx base metaphyseal closing wedge osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first ray corrective surgery with a comparable recurrence rate to the open alternative and high patient satisfaction.