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

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. (C) 2011 by the American College of Foot and Ankle Surgeons. All rights reserved.