Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash


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Medial approach to the hallux

This approach is indicated for fractures of the two phalanges of the hallux with or without joint involvement. It can also be used for ORIF of the medial sesamoid bone and for ORIF of distal fractures of the first metatarsal. It can also be used for treatment of hallux rigidus (cheilectomy, osteotomy, fusion).

Dorsal approach to MT1 & MTPJ

This approach is useful for tendon injuries and ORIF of the distal metatarsal, first MTP dislocations that are irreducible and proximal phalanx fractures.

Dorsal approach to P1

This approach is indicated for posttraumatic hammer toes.
It can be used for flexor tendon transfer to the first phalanx, PIP arthrodesis, MTP release, and/or extensor digitorum longus, or brevis, release or lengthening.

Plantar approach to DIP joint

This approach is indicated for

  • DIP flexion contractures
  • Correction of claw toe deformity secondary to:
      - Late compartment syndrome
      - Neurologic contractures
  • Arthrodesis of the DIP joint

Dorsal approach to DIP joint

This approach is indicated for an arthrodesis of a painful flexion contracture of the DIP joint.
Posttraumatic malunion with joint degeneration is another good indication for this approach.

In a combined procedure, a longitudinal incision may be a better choice as it allows for a possible extension.

v2.0 2017-03-23