How Important Is a Lesser Metatarsal Osteotomy in Preventing Second Hammertoe Recurrence?

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Podiatric Medicine

Background:

• Hammertoe deformities often recur after surgical correction, particularly those with significant preoperative transverse plane deformity.
• The role of intraoperative surgical techniques in mitigating recurrence risk remains unclear.

Purpose of the Study:

• To investigate whether transverse plane transposition and/or shortening of the second metatarsal during hammertoe surgery influences recurrence.
• To identify predictors of hammertoe recurrence, including specific intraoperative modifications.

Main Methods:

• Secondary analysis of pre-existing data from 102 patients (137 toes) who underwent second hammertoe surgery.
• Radiographic measurements of the second metatarsophalangeal joint and Cox regression analysis were used to assess recurrence predictors.

Main Results:

• Intraoperative lateral transposition of the metatarsal head was associated with an increased risk of hammertoe recurrence (multivariate HR 3.45, p = .028).
• Failure to achieve a satisfactory postoperative metatarsal parabola (long second metatarsal) also appeared to increase recurrence risk (multivariate HR 1.96, p = .097).

Conclusions:

• Lateral transposition of the metatarsal head may increase the risk of hammertoe recurrence.
• Shortening osteotomies might be beneficial for some patients, but further investigation is required for medial transposition techniques.