Percutaneous distal bicortical proximal phalanx osteotomy for second toe deformities - A two-year prospective cohort study.

Purpose: The main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second toe correction utilizing a novel distal and bicortical proximal phalanx osteotomy (DBPPO).

Methods: A minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic CHT deformities of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS).

Results: Between January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001).

Conclusion: Percutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up.

Level Of Evidence: Level II - Prospective cohort study.