Original Research| Volume 50, ISSUE 6, P687-694, November 2011

Proximal Phalangeal Osteotomy with Proximal Interphalangeal Joint Arthrodesis for Multiplanar Deformities of the Second Toe: Historical Perspectives and Review of a Case Series

Published:August 22, 2011DOI:


      Combined transverse and sagittal plane deformities of the second toe represent a common painful condition encountered by the foot surgeon. After a period of conservative management, surgical intervention is often required. Historically, a number of surgical options have been described for the treatment of this condition, with the universal acknowledgment that an ideal surgical outcome is difficult to achieve and prone to failure. In this report, a review of previously described surgical techniques is presented, along with a retrospective analysis of 20 second toe surgical reconstructions, in 16 patients, performed between June 2003 and October 2010. Subjective outcomes were assessed by means of a mailed questionnaire, and a subset (15 second toes in 11 patients) returned for follow-up evaluation, including ascertainment of American Orthopaedic Foot & Ankle Society Clinical Rating System for Lesser Metatarsophalangeal-Interphalangeal Joint Surgery scores. Overall, the duration of follow-up was 38.25 ± 25.82 months, and the subset was followed up for 36.07 ± 27.95 months. The preoperative visual analog pain score was 4.9 ± 2.7, whereas the postoperative pain score was 1.6 ± 2.47 (p < .001). The preoperative American Orthopaedic Foot & Ankle Society score was 44.57 ± 17.76, whereas the postoperative score was 91.27 ± 12.27 (p < .001). Based on the results of this investigation, pairing a basilar proximal phalangeal osteotomy with arthrodesis of the proximal interphalangeal joint, for correction of combined transverse and sagittal plane deformities, appears to yield satisfactory long-term results.

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        • Coughlin M.J.
        Crossover second toe deformity.
        Foot Ankle Int. 1987; 8: 29-39
        • Coughlin M.J.
        Subluxation and dislocation of the second metatarsophalangeal joint.
        Orthop Clin North Am. 1989; 20: 535-550
      1. Coughlin MJ. Lesser toe deformities. In Surgery of the Foot and Ankle, ed 7, pp. 365–370, edited by MJ Coughlin, RA Mann, Mosby, St. Louis, 1999.

        • Shurnas P.S.
        • Sanders A.
        Second MTP joint capsular instability with clawing deformity: metatarsal osteotomy, flexor transfer with biotenodesis, hammertoe repair, and metatarsophalangeal arthroplasty without the need for plantar incisions.
        Tech Foot Ankle Surg. 2005; 4: 196-201
        • Thompson F.
        • Hamilton W.
        Problems of the second metatarsophalangeal joint.
        Orthopedics. 1987; 10: 83-89
        • Yu G.V.
        • Judge M.S.
        • Hudson J.R.
        • Seidelmann F.E.
        Predislocation syndrome: progressive subluxation/dislocation of the lesser metatarsophalangeal joint.
        J Am Podiatr Med Assoc. 2002; 92: 182-199
        • O’Kane C.
        • Kilmartin T.E.
        The surgical management of central metatarsalgia.
        Foot Ankle Int. 2002; 23: 415-419
        • Coughlin M.J.
        • Schenk R.
        • Shurnas P.
        Concurrent interdigital neuroma and metatarsophalangeal joint instability: long-term results of treatment.
        Foot Ankle Int. 2003; 23: 1018-1025
        • Jarrett B.A.
        • Manzi J.A.
        • Green D.R.
        Interossei and lumbricales muscles of the foot; an anatomical and functional study.
        J Am Podiatr Med Assoc. 1980; 70: 1-12
        • Monson D.K.
        • Buell T.R.
        • Scurran B.L.
        Lesser digital arthrodesis.
        Clin Podiatr Med Surg. 1986; 3: 347-356
        • Davis W.H.
        • Anderson R.B.
        • Thompson F.M.
        • Hamilton W.G.
        Proximal phalanx basilar osteotomy for resistant angulation of the lesser toes.
        Foot Ankle Int. 1997; 18: 103-104
        • Nickisch F.
        • Davis W.H.
        Basilar proximal phalangeal osteotomy (Akinette) for the recalcitrant lesser-toe horizontal plane deformities.
        Tech Foot Ankle Surg. 2008; 7: 41-44
        • Kilmartin T.E.
        • O’Kane C.
        Correction of valgus second toe by closing wedge osteotomy of the proximal phalanx.
        Foot Ankle Int. 2007; 28 (1260–1214)
      2. Coughlin MJ. Lesser toe deformities. In Surgery of the Foot and Ankle, ed 8, p. 411, edited by MJ Coughlin, RA Mann, C Saltzman, Mosby, St. Louis, 2007.

        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        • Nunley J.A.
        • Myerson M.S.
        • Sanders M.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 320-325
        • Morton D.J.
        Metatarsus atavicus: the identification of a distinctive type of foot disorder.
        J Bone Joint Surg Am. 1927; 9: 531-534
        • Judge M.
        Current insights on treating second metatarsophalangeal joint dysfunction.
        Podiatry Today. 2011; 24: 28-34
        • Ibrahim T.
        • Beiri A.
        • Azzabi M.
        • Best A.J.
        • Taylor G.J.
        • Menon D.K.
        Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.
        J Foot Ankle Surg. 2007; 46: 65-74