- 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.
The veins are superficial and should be preserved, especially those which run longitudinally in the long axis of the toe. The arteries and the nerves are basically situated on the medial and on the lateral aspects of the toe.
The best approach to the toe is therefore in the sagittal plane, in line with the dorsal axis of the toe.
Make a longitudinal incision over the center of the toe from the MTP joint up to the PIP joint.
Division of the extensor tendon
Avoid cutting the longitudinally running veins. Expose the extensor tendon and incise it in a Z-shape fashion making a short transverse cut proximally and distally and then by cutting the extensor tendon itself in the midline.
Retract the cut tendon and expose the capsule. Then with scissors dissect out the sides of the joint capsule and insert small right angle retractors to protect the neurovascular structures on each side of the capsule.
Make a cut ¾ of the perimeter of the capsule. Do not cut the volar plate.
Close the wound with a running 4-0 self-absorbing suture. This makes suture removal unnecessary.