Indications
- Lesser MTP joint synovectomy and capsulotomy
- Weil osteotomy
- Dorsal plantar plate repair
- Extensor tendon lengthening for claw and hammer toes
- Freiberg disease debridement
- Removal of loose bodies and dorsal osteophytes
Position
- Supine with a thigh or ankle tourniquet
- Bump under the ipsilateral hip to bring the foot to neutral
- Image intensifier for osteotomy and wire placement
Landmarks and Incision
- Longitudinal dorsal incision centred on the MTP joint
- A web space incision allows access to two adjacent joints
- Palpate the metatarsal head and the MTP joint line while moving the toe
- Avoid placing incisions directly over prominent hardware sites
Superficial Dissection
- Identify and protect dorsal digital nerves
- Retract or Z-lengthen extensor digitorum longus, release extensor digitorum brevis if contracted
Deep Dissection
- Longitudinal capsulotomy exposes the metatarsal head
- Weil osteotomy is cut parallel to the sole
- Release the collateral ligaments to deliver the metatarsal head
- Plantarflex the toe to expose the plantar plate
- Preserve the plantar capsule unless repairing the plate
Structures at Risk
- Dorsal digital nerves and vessels
- Extensor tendons
- Plantar digital nerves during plantar plate work
- Metatarsal head blood supply with excessive stripping
Closure
- Repair or Z-lengthen tendons under appropriate tension
- Close skin with interrupted sutures
- K wire across the MTP joint if instability remains
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.