Flexor digitorum brevis (FDB) transfer (Pisani technique) in correcting metatarso-phalangeal joint (MtPj) instability of the second toe

Introduction. The plantar plate stabilizes the lesser toes via the plantar fascia and the reverse windlass mechanism. The maintenance of intrinsic and extrinsic muscle balance of the toe is mandatory. Surgical Technique. Patient is positioned supine with Trendelenbourg for plantar approach. Material and method. We report in a prospective study the results of eight patients first evaluated after 6 month FU (10) and a second. Evaluation after 3 years FU is going on. Results. Pre operative AOFAS scores ( for lesser rays) mean 42 (14-65). At 6months FU there were mean 89 (75-100). Discussion. The FDL transfer is known to lead to residual stiffness that appeared to be the source of the mild residual pain and cause patient dissatisfaction. There is also a potential complications such as the loss of strong toe grasp. Conclusion. The FDB transfer is technically more demanding than FDL transfert because the little diameter of the tendon arms, but is a logical procedure using an intrinsic muscle.