Wire-Guided Percutaneous Drill Osteotomy for Symptomatic Lesser Toe Deformities: A Case Report

Lesser toe malalignment can cause recurrent interdigital skin injury and limit footwear tolerance. We report the clinical course of a 53-year-old man with flexible medial deviation of the left fourth and fifth toes, recurrent pressure lesions, and shoe intolerance despite repeated lesion-directed treatment. Corrective proximal phalangeal osteotomies were performed using a standard orthopaedic drill and fluoroscopy when a dedicated percutaneous burr system was unavailable. A 1.0 mm guidewire was placed from dorsal to plantar, perpendicular to the toe long axis. In both toes, sequential 2.0, 2.7, 3.5, and 4.0 mm drilling was followed by controlled closure around a preserved medial hinge. Retrograde 1.5 mm Kirschner wires maintained correction without metatarsophalangeal joint transfixation and were removed on postoperative day 43. At postoperative day 46, the pressure-related hyperkeratotic lesion had resolved, the reported visual analogue scale pain score was 0, the patient reported tolerating conventional footwear, and alignment was maintained. Radiographs showed interval osseous healing without secondary displacement; no wound, pin-tract, or neurovascular complication was observed. This case documents short-term clinical improvement after an adaptation of available instruments. The brief follow-up and single-patient design preclude conclusions about mature union, durability, overall safety, or comparative effectiveness.