title: Correction of multiplanar deformity of the second toe with metatarsophalangeal release and extensor brevis reconstruction.
abstract: BACKGROUND
  Surgical treatment of multiplanar (varus and dorsal angulation) second toe deformities due to degenerative instability can lead to recurrence, stiffness, and pain. The goal of this study was to evaluate the short-term outcomes associated with a new technique using an extensor digitorum brevis (EDB) tendon reconstruction to correct such deviation of the second metatarsophalangeal (MTP) joint.
  
  
  METHODS
  Ten patients (10 female, 0 male) with 11 operated second toes having undergone correction with a reconstruction using the EDB tendon were assessed at an average of 18.5 months (range, 12-34) after surgery. The technique was indicated when MTP and medial partial plantar plate release alone were not sufficient to correct multiplanar deformity. Radiographic parameters (AP and lateral metatarsal-proximal phalanx angles), physical exam (MTP joint range of motion), and subjective outcomes (the Foot and Ankle Outcome Score [FAOS]) were assessed. A toe-specific survey captured more detailed subjective information, including patient satisfaction.
  
  
  RESULTS
  Preoperatively, the average MTP joint angle was 4.5 degrees in the varus direction, which changed to 14.2 degrees in the valgus direction postoperatively. On exam, the average MTP joint range of motion was 60.9 ± 11.6 degrees dorsiflexion and 11.1 ± 2.5 degrees plantarflexion. Postoperative FAOS scores demonstrated an average of 89.9 ± 9.8 for the symptoms domain. In all, 9 of 11 patients were either highly satisfied or moderately satisfied (none dissatisfied).
  
  
  CONCLUSIONS
  With the stated limitations, the EDB tendon reconstruction technique described in conjunction with collateral ligament and partial plantar plate release provided powerful correction. Minimal release of the medial plantar plate and not overtightening the reconstruction are recommended to avoid shifting the toe in the opposite direction.
  
  
  METHODS
  Level IV, retrospective study.
authors: Hospital for Special Surgery, New York, NY 10021, USA. ellis@hss.edu
authors: Scott J
authors: SJ
authors: Ellis
authors: Elizabeth
authors: E
authors: Young
authors: Yoshimi
authors: Y
authors: Endo
authors: Huong
authors: H
authors: Do
authors: Jonathan T
authors: JT
authors: Deland
mesh_terms: D000368:Aged; D017885:Collateral Ligaments / Q000601:surgery; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D050277:Toe Phalanges / Q000601:surgery; D014034:Toes / Q000601:surgery*
keywords: crossover toe; ligament reconstruction; second MTP joint; tendon reconstruction