Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx
Category: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and tran...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2020-10-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011420S00397 |
| _version_ | 1811292279973871616 |
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| author | Robbie Ray Peter W. Robinson Paul M. Dearden Thomas A. Goff Peter Lam MBBS, FAOrthA, FRACS(Orth) Thomas L. Lewis MD |
| author_facet | Robbie Ray Peter W. Robinson Paul M. Dearden Thomas A. Goff Peter Lam MBBS, FAOrthA, FRACS(Orth) Thomas L. Lewis MD |
| author_sort | Robbie Ray |
| collection | DOAJ |
| description | Category: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe. Methods: 29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests. Results: 90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe. Conclusion: Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques. |
| first_indexed | 2024-04-13T04:43:03Z |
| format | Article |
| id | doaj.art-33429dda27474f5492040055c4830f90 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-13T04:43:03Z |
| publishDate | 2020-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-33429dda27474f5492040055c4830f902022-12-22T03:01:56ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142020-10-01510.1177/2473011420S00397Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal PhalanxRobbie RayPeter W. RobinsonPaul M. DeardenThomas A. GoffPeter Lam MBBS, FAOrthA, FRACS(Orth)Thomas L. Lewis MDCategory: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe. Methods: 29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests. Results: 90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe. Conclusion: Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques.https://doi.org/10.1177/2473011420S00397 |
| spellingShingle | Robbie Ray Peter W. Robinson Paul M. Dearden Thomas A. Goff Peter Lam MBBS, FAOrthA, FRACS(Orth) Thomas L. Lewis MD Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx Foot & Ankle Orthopaedics |
| title | Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx |
| title_full | Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx |
| title_fullStr | Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx |
| title_full_unstemmed | Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx |
| title_short | Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx |
| title_sort | correction of valgus lesser toes by percutaneous closing wedge osteotomy of the proximal phalanx |
| url | https://doi.org/10.1177/2473011420S00397 |
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