Lesser toe deformities can be corrected in the same way as for non-neurological deformities:
- fully flexible deformities (type 1) with a Girdlestone-Taylor flexor-extensor transfer
- type 2 toes with a fixed PIPJ deformity with a PIPJ excision arthroplasty or fusion
- type 3 toes with fixed flexion at the PIP joint and fixed extension at the MTP joint with a PIPJ excision arthroplasty or fusion plus MTPJ soft tissue release, or with a Stainsby procedure
Hallux clawing can be corrected with the Jones transfer (EHL to the metatarsal neck plus hallux IPJ fusion or tenodesis); in the adult there is usually a fixed plantar flexion deformity of the first metatarsal and a dorsiflexion osteotomy is required. Sammarco (2001) reported combined calcaneal and first metatarsal osteotomies in 21 feet, with an improvement in the mean AOFAS ankle-hindfoot score from 46 to 89 and in the midfoot score from 41 to 89 at a mean follow-up of 4 years. There were 3 non-unions of metatarsal osteotomies. Three of these patients also had Jones transfers
Lesser metatarsal plantar flexion can be corrected with a procedure analogous to the Jones, with the Hibbs tenosuspension technique or with an alternative metatarsal osteotomy such as the BRT technique.