CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-MIS in Lesser Toe Deformities

Video Transcription

Video Summary

Chris Miller reviews advanced minimally invasive surgery (MIS) techniques for lesser-toe (hammer toe) deformity, building on Part 1’s PIP fusion concepts. Using a key reference article and its decision tree, he stresses first classifying deformities as flexible vs semi-rigid vs rigid, and recognizing when open surgery remains appropriate (especially rigidly dislocated MTP joints). He outlines MIS soft-tissue releases: a percutaneous PIP release (plantar plate and both FDB slips) to convert semi-rigid toes to flexible, and a dorsal MTP release (extensor tendons/capsule) to reduce dorsiflexion contracture while preserving tissue that helps tendon healing. Then he covers “à la carte” osteotomies—P1 plantarflexion uni/bicortical cuts (including rotation/coronal correction), optional P2 dorsiflexion osteotomy, and shortening options. He presents outcomes literature showing high satisfaction and fewer pin-related problems, with swelling common. Case examples demonstrate combining releases, osteotomies, fusions, and metatarsal shortening (DMMO). Post-op strapping/skinplasty is emphasized to maintain alignment without pins.

Asset Subtitle

In this lesson, Dr. Chris Miller presents part two on advanced minimally invasive surgery (MIS) techniques for lesser-toe (hammer toe) deformity, building on Part 1’s PIP fusion concepts.

Keywords

minimally invasive surgery (MIS)

lesser-toe hammer toe deformity

flexible vs rigid deformity classification

percutaneous soft-tissue release (PIP/MTP)

toe osteotomies (P1/P2)

metatarsal shortening osteotomy (DMMO)