**7. Other toe problems**

Painful hammer, mallet or claw toes, especially with progressive toe callus, are offered toe flexor tenotomy after failure of non-operative treatment. These procedures are also done both for pain relief and to help prevent future ulcers in diabetic patients. Percutaneous capsulotomy and/or percutaneous phalangeal osteotomy are performed if correction is insufficient. Percutaneous interphalangeal joint resection and fusion is less commonly performed. Percutaneous pins are used as needed and removed at 3 weeks.

For interdigital corns of the first web space, patients are offered percutaneous shaving of bone under corn and adductor tenotomy of first metatarsal-phalangeal (MP) joint. Interdigital corns of lessor toes may have percutaneous shaving of bone under corn and capsular release in the lessor toe MP joint in addition if needed.

Inactive high-risk patients with painful arthritis of the first MP joint can be treated initially with percutaneous FHL tenotomy to relieve pain and prevent ulceration with less expected complications than with bone surgery [69]. More commonly, percutaneous resection of bone spurs, dorsal MP joint (cheilectomy)and proximal phalangeal dorsal closing wedge osteotomy is performed [70]. DePrado's book on percutaneous is an excellent "how to" book on percutaneous foot surgery [70].

For bunions, percutaneous or open chevron metatarsal osteotomy and proximal phalanx osteotomy are performed [70, 71]. Most patients having first ray surgery for arthritis or bunions also have GSR for Achilles tightness. If they have diabetes, GSR will more likely relieve their pain and prevent foot ulcers, Charcot foot and amputation [41, 57]. If they have Achilles tendinitis, posterior tibial tendinitis or dysfunction, midfoot arthritis or metatarsalgia in addition to their first MP pain, they are more likely to have their pain relieved than if they have bunionectomy alone [41, 68].
