Joint-Preserving Percutaneous Kirschner-Wire Arthrorisis for Chronic Lesser Toe Metatarsophalangeal Dislocation

Background: Lesser toe metatarsophalangeal (MTP) joint instability is a frequent cause of forefoot pain and may progress to fixed dorsal dislocation. No consensus exists regarding the optimal management of chronic MTP dislocations, and traditional reconstructive techniques such as plantar plate repair or Weil osteotomy remain technically demanding. The purpose of this study was to evaluate the outcomes of percutaneous Kirschner-wire (K-wire) MTP arthrorisis combined with minimally invasive distal metatarsal osteotomy for chronic lesser toe MTP dislocation. Methods: We retrospectively reviewed 48 consecutive patients (57 feet) treated between November 2020 and April 2024 for chronic lesser toe MTP dislocation graded 3 or 4 according to the Borne and Myerson classifications. All patients underwent extensor tenotomy, MTP capsular release, and percutaneous K-wire arthrorisis combined with distal metatarsal minimally invasive osteotomy or distal oblique metatarsal minimally invasive osteotomy. Outcomes included the European Foot and Ankle Society (EFAS) score, the Simple Foot and Ankle Value (SFAV), patient satisfaction, footwear accommodation, radiographic consolidation, residual deformity, and complications. Minimum follow-up was 24 months. Results: At a mean follow-up of 45.1 months (SD 11.6; range, 26-63), the mean EFAS score was 21/24 (SD 4.1) and the mean SFAV was 81% (SD 19%). Return to normal footwear was achieved in 37 patients (77.1%), and 45 patients (93.8%) reported they would undergo the same procedure again. Osteotomy consolidation was confirmed in 56 feet (98.2%). Residual dislocation occurred in 3 feet (5.3%). No floating toe and no transfer metatarsalgia were observed. Complications included 1 wound complication (1.8%), 3 superficial infections (5.3%), 1 complex regional pain syndrome (1.8%), and 19 postoperative stiffness (39.6%). Conclusion: Percutaneous K-wire MTP arthrorisis combined with minimally invasive distal metatarsal osteotomy was associated with reliable stabilization of chronic lesser toe MTP dislocation, with high satisfaction and no floating toe at nearly 4 years’ follow-up in 57 feet. Level of Evidence: Level IV, retrospective case series.