REVIEW
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[Minimally invasive correction of lesser toe deformities and treatment of metatarsalgia].

OBJECTIVE: Atraumatic and joint-sparing procedure for the correction of lesser toe deformities by using a linear or perpendicular osteotomy of the proximal and/or middle phalanx of the lesser toes with additional capsulotomies or tendon dissection for soft tissue realignment. Metatarsalgia is addressed via an extracapsular distal metaphyseal crescentic-like metatarsal osteotomy.

INDICATIONS: Symptomatic lesser toe deformities, painful pseudoexostosis, metatarsalgia, symptomatic metatarsal malalignment, metatarsus adductus.

CONTRAINDICATIONS: Infection or malperfusion of the forefoot, dislocation at metatarsophalangeal joint level, noncompliance.

SURGICAL TECHNIQUE: Correction of lesser toe deformities via fluoroscopy-guided minimally invasive surgical technique. Osteotomy of the proximal and middle phalanx is combined with a plantar capsulotomy of the proximal interphalangeal joint. Condylectomy of the head of the proximal phalanx, tenotomy of the extensor digitorum longus tendon proximal to the joint line in combination with tenotomy of the short flexor tendons at the level of proximal interphalangeal joint can be necessary. Distal metatarsal osteotomies are performed with a micro-burr starting from plantar-medial parallel to the metatarsal shaft axis ending dorsally perpendicular to the metatarsal shaft axis.

POSTOPERATIVE MANAGEMENT: Taping for external stabilization of the lesser toes as well as self-adhesive bandage to stabilize the metatarsals for 6 weeks; early weight-bearing is possible.

RESULTS: A prospective study of minimally invasive distal metaphyseal metatarsal osteotomies (DMMO; 30 patients, n = 73 osteotomies) and Weil osteotomies (30 patients, n = 45 osteotomies) showed similar results after a mean follow-up of 13 months. The surgery time was significantly shorter for the minimally invasive technique, but radiation exposure for the surgeon and patient were higher.

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