PMC7700055_01
(a) Splay toe between 2nd and 3rd toe. (b) Dynamic analysis of the foot while weight bearing. (c) Plane X-ray of the foot showing Smillie stage V necrosis of the 2nd metatarsal head causing the splay toe deformity with a relatively long 3rd metatarsus.
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A 62-year-old female presented a metatarsalgia of the right mid- and forefoot with a splay toe two-to-three (Figure 1(a)). Walking analysis showed worsening symptoms of pain and deformity while weight bearing (Figure 1(b)). X-ray in the ap view showed the deformity weight bared (Figure 1(c)).  Figure 2(a) showed the deformity in the lateral view.
Lateral radiograph prior surgery and at three months follow-up.
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X-ray in the ap view showed the deformity weight bared (Figure 1(c)).  Figure 2(a) showed the deformity in the lateral view. X-rays were taken to evaluate radiological outcome in ap view (Figure 5(c)) and lateral view (Figure 2(b)).
Schematic chart of the surgical procedure for splay toe correction: Modified Weil's osteotomy with a lateral rotation of the metatarsal head. Extensor brevis tendon transfer from the second ray to the base of the proximal phalanx of the third toe.
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The operation is shown on the schematic chart in Figure 3.
Intraoperative X-ray after realignment performing Weil's osteotomy, extensor brevis transfer, and temporary arthrodesis of the second toe.
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K-wire was inserted in a temporary arthrodesis to keep the axis with partial weight bearing (Figures 4(a) and 4(b)). K-wire removal was performed after 6 weeks with subsequent return to full weight bearing (Figure 5(a)).
Results at the 3-month follow-up after removing the K-wire, with (a) photograph while weight bearing, (b) walking analysis, and (c) plane X-ray.
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K-wire was inserted in a temporary arthrodesis to keep the axis with partial weight bearing (Figures 4(a) and 4(b)). K-wire removal was performed after 6 weeks with subsequent return to full weight bearing (Figure 5(a)). Technical walking analysis was performed for the functional outcome (Figure 5(b)). X-rays were taken to evaluate radiological outcome in ap view (Figure 5(c)) and lateral view (Figure 2(b)).