[Minimally invasive lesser toe surgery]

Minimally invasive techniques have substantially changed the surgical management of lesser toe deformities. The therapeutic objective is a tissue-sparing correction that restores function, improves alignment, and achieves a favorable cosmetic result with minimal surgical morbidity. Indication for surgery requires a detailed clinical assessment of the deformity at the metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, including the affected plane, severity, and degree of flexibility or rigidity.

The operative strategy is based on a sequential concept combining soft-tissue and osseous procedures as required. Percutaneous tenotomies and capsulotomies may be supplemented by minimally invasive phalangeal osteotomies, proximal and distal interphalangeal joint arthrodeses, exostosis and condylar resections, and distal minimally invasive metatarsal osteotomies, allowing multiplanar correction. Internal fixation is usually not required, as postoperative alignment is maintained by corrective taping.

Minimally invasive correction of lesser toe deformities provides effective realignment with low complication rates and allows early functional postoperative management. In severe, rigid, or dislocated deformities, combined open procedures may remain necessary.