Background: Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. Methods: A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. Results: The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = − 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). Conclusion: The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. Trial registration: The study was based on retrospectively registered data starting on May 24, 2008.

Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority.

Background and aims: Digital deformity in flexion, varismus (external rotation), and adduction with the toe in both supraduction and infraduction are called clinocampodactyly or curly toe. All adult patients with symptoms and a diagnosis of semirigid/rigid curly toes underwent radiological examination to verify the presence of a trapezoidal phalanx. The purpose of this study was to quantitatively determine the degrees of improvement of a dysmetric phalanx after incomplete phalangeal osteotomy using minimally invasive surgery. The points of improvement were determined using the American Orthopedic Foot and Ankle Society (AOFAS) scale score.Methods: Between May 2021 and June 2022, 30 patients diagnosed with curly toes underwent unicortical osteotomy of the affected phalanx. The convergence angle was measured and the AOFAS scale scores were compared.Results: A total of 33 toes underwent surgery. The average reduction of the convergence angle was 9°. The average improvement in the AOFAS scale score was 53 points at 6 months and reached almost 90 points (89.9 ± 6.1 points).Conclusions: Incomplete phalangeal osteotomy performed with minimally invasive surgery of the trapezoidal phalanges of curly toes of adults can improve alignment and AOFAS scale scores.

Background/Objectives: Hyaluronic acid (HA) is a natural substance in the human body with anti-inflammatory and healing properties that help repair bone by supporting cell growth, blood vessel formation, and tissue structure. A common complication after minimally invasive surgery is delayed bone healing in osteotomies. HA may offer a useful treatment to support faster recovery. Methods: This systematic review followed PRISMA guidelines and was pre-registered in PROSPERO (ID: CRD420250654929). Searches were conducted in PubMed, EbscoHost, Web of Science, and Scopus up to 25 January 2025. Studies from the last five years on HA and bone healing were included. The main outcomes were faster bone repair and improved regeneration. Study quality was assessed using the OCEBM, ROBINS-I, and GRADE tools. Results: Out of 96 studies, 9 met the inclusion criteria. HA, especially when combined with other materials or stem cells, helped bone repair by supporting new bone formation. Materials like 3D-printed scaffolds, hydrogels, and meshes showed good results in bone healing. However, differences in the study design made direct comparison difficult. Conclusions: Hyaluronic acid shows promise for bone repair, especially in combination with other materials. More standardized clinical trials are needed to confirm its effectiveness and define how best to use it in minimally invasive surgeries.

Minimally invasive foot surgery (MIS) has become a common procedure to treat various pathologies, and accuracy in the angle of metatarsal osteotomies is crucial to ensure optimal results. This randomized controlled trial with 37 patients investigates whether the implementation of a digital inclinometer can improve the accuracy of osteotomies compared to traditional freehand techniques. Patients were randomly allocated to group A (n = 15) receiving inclinometer-assisted surgery or group B (n = 22) receiving conventional surgery. Osteotomies were performed and outcomes were evaluated using an inclinometer. The inclinometer group showed a significant decrease in plantar pressure from 684.1 g/cm² pretreatment to 449.5 g/cm² post-treatment (p < 0.001, Cohen’s d = 5.477). The control group decreased from 584.5 g/cm² to 521.5 g/cm² (p = 0.001, Cohen’s d = 0.801). The effect size between groups was large (Cohen’s d = −2.572, p < 0.001). The findings indicate a significant improvement in accuracy and reduction in outliers when using an inclinometer, suggesting that this technology has the potential to improve surgical practice and patient outcomes in minimally invasive metatarsal osteotomies.

Background and Objectives: Minimally invasive distal metatarsal osteotomy (DMMO) has established itself as an effective surgical technique for the treatment of metatarsalgia, notable for its reduced postoperative pain and faster recovery. However, doubts remain regarding the frequency and nature of postoperative complications. The objective of this systematic review and meta-analysis was to evaluate the incidence of the most frequent complications associated with the DMMO technique, including prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain. Materials and Methods: A systematic review was conducted following the PRISMA 2020 guidelines, with the protocol registered in the PROSPERO database (CRD420251067666). Searches were conducted in the PubMed, Scopus, and Web of Science databases, including clinical studies published between 2010 and 2025. The inclusion criteria covered studies in adults treated with DMMO and reporting postoperative complications. The methodological quality assessment was performed using Joanna Briggs Institute (JBI) tools according to the design of each study. Random-effects models were used for the meta-analyses, assessing heterogeneity using the I² statistic. Results: Fifteen studies with a total sample of more than 493 patients were included. Prolonged edema was the most common complication (30.91%), followed by delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%). Less frequent complications included nonunion, infections, necrosis, and bone misalignments. The combined incidence of floating toe was 40% (I² = 0%), while prolonged edema showed considerable heterogeneity (I² = 88.3%). The overall quality of the evidence was considered moderate to low, mainly due to the predominance of observational studies. Conclusions: The DMMO technique represents a minimally invasive surgical option with generally favorable results. However, some complications, such as prolonged edema and floating toe, have a significant incidence. The methodological variability between studies highlights the need for standardized protocols and higher-quality prospective studies to establish the safety profile of this technique more accurately.