# Correction of lesser toe deformities: minimally invasive versus open surgery—a prospective randomised study

## TL;DR

This study compares minimally invasive and open surgery for lesser toe deformities, finding similar outcomes but fewer complications with the minimally invasive approach.

## Contribution

A prospective randomized trial comparing clinical and functional outcomes of two surgical techniques for lesser toe deformities.

## Key findings

- Minimally invasive surgery had fewer wound complications compared to open surgery.
- Both techniques showed comparable clinical and radiological corrections of lesser toes.
- Open surgery resulted in significantly more non-unions compared to minimally invasive surgery.

## Abstract

To compare soft and hard outcome measures after minimally invasive (MIS) and open (OS) surgical treatment of lesser toe deformities. It was hypothesised that MIS would be associated with fewer complications and comparable subjective and objective results.

A prospective randomised controlled study was designed. One hundred patients were included consecutively and allotted via block randomisation to two groups. The presence of co-pathologies at the forefoot and midfoot, which were treated simultaneously, was not an exclusion criterion. However, these cases were analysed to ensure an equal distribution across the study groups. Patients were evaluated clinically, functionally, and radiologically prior to surgery and at a 1.5-year follow-up. Additionally, they were asked about their personal satisfaction via patient-reported outcome measures.

The distribution of co-pathologies at the foot was not significantly different between the two study groups. The same is true of co-morbidities. Significantly more wound complications, including infections, were found in the open surgery group (p = 0.029). K-wire issues were distributed equally between the groups, but differed in their clinical manifestation (p = 0.03). Only seven out of the 95 patients finally examined were dissatisfied with their long-term results, with an equal distribution between both groups (four MIS vs. three OS, p = 0.914). Clinical and radiological corrections of the lesser toes were comparable in both groups, but the open surgery (OS) group showed significantly more non-unions (p = 0.0013). Functional evaluation via the FFI-D (Foot Function Index Germany), a reliable, validated, internationally used, standardised questionnaire to assess the correlation between foot deformity and function, demonstrated relevant postoperative improvement in all patients, with no difference between the two technical approaches (p = 0.460).

Lesser toe surgery is a low-risk treatment with good overall results. MIS offers equivalent clinical outcomes to OS with a lower risk of complications in terms of soft tissue and bone healing.

Level 1 Prospective randomised controlled study. TRN DKRS00034137 25/04/2024.