Correction of lesser toe deformities: Minimally invasive versus open surgery – A prospective randomized study

Purpose This study aimed to compare soft and hard outcome measures after minimally invasive (MIS) versus open surgical treatment (OS) of lesser toe deformities. We hypothesized that minimally invasive treatment would be associated with fewer complications alongside comparable subjective and objective results. Methods A prospective randomized controlled study was designed. 100 patients were included and randomized into two groups. The patients were evaluated clinically, functionally and radiologically prior to surgery and in a follow up of 1.5 years, resp. Additionally, they were asked about their personal satisfaction via patient-reported outcome measures. Results As anticipated, we found significantly more wound complications including infections in the open surgery group (p = 0.029). K-wire issues were distributed equally between the groups but differed in their clinical appearance (p = 0.03). Hospital stay was significantly reduced in the MIS group (p = 0.004). Only 7 out of the finally examined 95 patients were dissatisfied with their long-term results equally distributed between both groups (4 MIS vs. 3 OS, p = 0.914). The clinical and radiological corrections of the lesser toes were comparably good in both groups, but the open surgery group showed significantly more non-unions (p = 0.0013). The functional evaluation via FFI-D (Foot Function Index Germany), a validated reliable and internationally used standardized questionnaire to assess the correlation between foot deformity and function, also demonstrated a relevant improvement of all patients’ abilities postoperatively without any difference between the two technical approaches (p = 0.460). Conclusion Lesser toe surgery is a low-risk treatment with good overall results. Minimally invasive surgery offers equivalent clinical outcomes with lower risk of complications in soft tissue and bone healing. Level of evidence Level 1 prospective randomized controlled study. TRN DKRS00034137, 25.04.2024