Z-type shortening osteotomy of the proximal phalanx: A novel and safe joint sparing intervention to shorten lesser toes with good short-term outcome

Philipp Friederichsen; Melissa Wilhelmi; Pascal Rippstein

doi:10.1016/j.fas.2025.06.004

Z-type shortening osteotomy of the proximal phalanx: A novel and safe joint sparing intervention to shorten lesser toes with good short-term outcome

Foot Ankle Surg. 2025 Jun 18:S1268-7731(25)00158-4. doi: 10.1016/j.fas.2025.06.004. Online ahead of print.

Authors

Philipp Friederichsen¹, Melissa Wilhelmi², Pascal Rippstein³

Affiliations

¹ Department of Foot Surgery, Schulthess Klinik, Zurich, Switzerland. Electronic address: philipp.friederichsen@kws.ch.
² Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland.
³ Department of Foot Surgery, Schulthess Klinik, Zurich, Switzerland.

PMID: 40579345
DOI: 10.1016/j.fas.2025.06.004

Abstract

Background: Overlength of the lesser toes can lead to pain at the distal toe end and painful hammer and claw deformities. Fusion or resection of proximal interphalangeal joints are commonly used to address overlength, while sacrificing joint mobility. A Z-type shortening osteotomy of the proximal phalanx (SOPP) was developed as a joint-sparing alternative.

Methods: We outline this novel technique and retrospectively analyzed preliminary data from 13 patients (including 9 women) with a mean age of 42 years who underwent Z-type SOPP. Patients rated their postoperative satisfaction and assessments of radiographs and complications were made up to 1-year post-SOPP.

Results: Of 29 toes in total, mean postoperative shortening was 6.4 mm (range, 4-11 mm) and all showed complete union at 1 year. All patients were satisfied with the surgery and only two reported limited joint mobility. There were no reports of infection and delayed wound healing.

Conclusion: Z-type SOPP appears to be an effective and safe joint sparing treatment for lesser toe overlength in the short term.

Level of evidence: Retrospective case series, Level IV.

Keywords: Complications; Foot deformities/surgery; Lesser toe shortening, lesser toe overlength; Osteotomy; Patient satisfaction; Proximal phalanx.