Comparative Evaluation of Effectiveness of Lesser Toe Surgical Correction

INTRODUCTION: The relevance of improving algorithms of surgical correction of lesser toes (SCLT) is due to a high incidence of hammertoe deformity syndrome, its negative impact on the working capacity and quality of life, and to a considerable degree of dissatisfaction of patients with the results of surgical treatment.

AIM: To evaluate the effectiveness of an improved SCLT algorithm using a modified fixed B. Helal osteotomy and combined plantar plate (PP) and toe flexor tendon repair.

MATERIALS AND METHODS: The prospective study included 167 female patients with a severe deformity of the second lesser toe. In 83 patients of the control group, the stability of the metatarsophalangeal joint was restored through surgical PP repair. In the main group (n = 84), along with elimination of PP defect, the second toe flexor tendon repair was performed. The condition of the second lesser toe before and one year after its surgical correction was evaluated using clinical and X-ray methods and a questionnaire.

RESULTS: At the stage of assessing the long-term results of treatment in the main group, the integral score of ACFAS Module 2 scale increased by 63 points relative to the preoperative value, which appeared to be 22 points more (U_emp = 3687, U_cr = 4894, р ˂ 0.01) than a similar change in the control group. One year after surgery, the incidence of the floating toe syndrome and its residual hyperextension in the main group decreased by 10.8% (φ*_emp = 0.007, р ˂ 0.05) and 8.8% (φ*_emp = 0.016, р ˂ 0.05), respectively.

CONCLUSIONS: Application of the improved algorithm permitted to improve the SCLT effectiveness, which was confirmed by a statistically significant improvement of the long-term results of treatment of patients in the main group compared to the control group.