Minimally invasive surgery for pedal digital deformity: a systematic review

Objective: The interest and application of minimally invasive surgery (MIS) in treating lesser toe deformities have increased worldwide. The symptoms are often attributed to callosities and localized pressure. Conservative treatment may improve comfort, but its success largely depends on the level of deformity. When conservative treatment fails, surgery may be indicated. This study explores the available evidence and reviews in the literature seeking to examine the efficacy of MIS in lesser toe pathology. Methods: A systematic review was performed, and the search included the following databases: Cochrane Library, CINAHL, MEDLINE®, PUBMED, Science Direct, and other relevant peer-reviewed sources between September 2019 and June 2022. In addition, a manual search was conducted in Australian, American, British, and European orthopedic and podiatric scientific data for relevant studies. Results: The search for potentially eligible information for this systematic review yielded 92 unique studies. All studies identified were obtained and reviewed. An updated search was performed in July 2022, resulting in no additional studies that satisfied the inclusion criteria. After considering all potentially eligible studies, five (5.4%) met the inclusion criteria. One thousand one hundred eighty-six lesser toe procedures (500 patients) were included. The overwhelming majority of patients were female (80.5%). The patient’s mean age was 56.9 (range 18-91) years, and the mean follow-up was 19.6 (range 6-33) months. All of the studies included early mobilization in the postoperative protocol. Conclusion: There is a need for more research using a combination of validated patient-reported outcomes to evaluate the effectiveness of MIS procedures in treating lesser toe deformities alongside the development of validated and tested treatment algorithms to guide surgical decision-making. Level of Evidence III; Therapeutic Studies; Systematic Review.