Lesser toe problems

Last evidence check March 2011

Principal authors: Jim Barrie and Patrick Whatmough

The MTP soft tissue release is based on the cadaver work of Myerson and Shereff (1990). They found that release of dorsal skin contracture, extensor tendons, dorsal MTP joint capsule and collateral ligaments was required to fully correct a hammertoe deformity. We carried out the full release for every hammertoe in a series published by Hossain et al (2003). Overall clinical results were much the same as those reported for less aggressive procedures, with about 82% satisfactory results. There were no recurrent deformities, but some toes were over-corrected and a few patients had persistent MTP joint pain. We have now reverted to a more selective approach to MTP release. Once we have evaluated the results of such an approach it should be possible to design a trial to give more accurate information.

Currently we recommend MTP soft tissue release (with PIP joint excision arthroplasty) for type 3 toes, where there is fixed flexion of the PIP joint and fixed hyperextension of the MTP joint. Some type 2 toes, in which the MTP joint hyperextension is passively correctable, still have unacceptable hyperextension after correction of the PIP joint deformity and benefit from an additional MTP joint release. Although many series reporting PIP joint correction mention that some form of MTP joint release (often percutaneous extensor tenotomy) was performed in some toes, they do not record how many. Our impression is that 30-40% of toes need an MTP release.

The MTP soft tissue release also plays a part in reducing some toes with a fixed dislocation of the MTP joint.