Interphalangeal joint arthrodesis of the lesser toes.

Fusion of the PIP joint of the lesser toes provides sound correction of deformity of that joint. Fusion is achieved reliably in most cases and fibrous ankylosis is well tolerated in those that fail. Patients at the extremes of the age scale are perhaps less tolerant of the procedure; complaints include poor cosmesis and subjective lack of control of the toes [18]. Although fusion of the DIPJ is a sound primary procedure, it would seem prudent to reserve PIP fusion as a revision procedure [7] or for the treatment of severe, fixed hammer toe deformities. For flexible or mild, fixed hammer toe deformities, consideration should be given to the use of tendon lengthening or transfer surgery in association with joint release as the primary approach to correct the deformity. Complete failure of surgery occurs when muscular imbalance or pre-existing deformity at another level is not properly addressed. This may result in patient complaints of persistent metatarsalgia or toe deformity despite a successful PIP fusion. The use of either sound fixation or a stable bony construct is recommended, as it is likely to reduce the incidence of mal-union and non-union.