Lesser Toe Deformity Correction

Indications

Lesser Toe Abnormalities, hammer toes
Hammer toes. Image by Wwcmdmsha at neurosigns.org, Wikimedia Commons, CC BY-SA 4.0.
  • Painful hammer, claw or mallet toes failing footwear changes
  • Subluxed or dislocated lesser MTP joints
  • Callosities over the PIP joint or the tip of the toe
  • Second toe crossover deformity

Position

  • Supine, ankle tourniquet
  • Bump under the ipsilateral hip
  • Image intensifier for wire placement

Operative Steps

  1. Flexible deformity, FDL to extensor transfer (Girdlestone Taylor)
  2. Fixed PIP deformity, resection arthroplasty or fusion held with a K wire
  3. MTP extension contracture, extensor lengthening and dorsal capsulotomy
  4. Subluxed MTP joint, Weil shortening osteotomy with plantar plate repair if needed
  5. Check toe perfusion after straightening
  6. Assess flexibility with the push up test before deciding on the procedure
  7. Mallet toe, DIP resection arthroplasty or fusion with FDL tenotomy
  8. Pass the K wire retrograde across the PIP joint and back into the proximal phalanx, crossing the MTP joint if it was subluxed
  9. Address hallux valgus at the same time if present

Postoperative Care

  • Postoperative shoe, wires out at about 4 to 6 weeks
  • Heel weight bearing in the postoperative shoe
  • Taping or splinting for 6 weeks after wire removal
  • Swelling can persist for several months

Complications

  • Floating toe after Weil osteotomy
  • Recurrence
  • Vascular compromise of the toe
  • Pin tract infection and wire breakage
  • Stiffness and residual deformity
  • Transfer metatarsalgia

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.