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Looking for opinions on surgical treatment of lateral lister's corn with adductovarus5th digit to achieve best outcome.

 

If the frequent callous debridement is not reducing symptoms, surgery is the nest step. I like the arthroplasty of the intermediate phalanx with a lenitcular incision to derotate the adductovarus of the 5th toe.

 

According with Nellermoe's answer I think surgery is the best option to assure the success of the treatment of Lister's corn, but I would place another therapeutic step between debridation and surgery... Silicone Orthotics.
Sometimes we can make a silicone orthosis specially designed for each case. I use to do it in patients of risk or patients who are not convinced or ready to surgical procedures. Silicone orthotics run well and in a great number of cases avoid surgery in an early stage of deformity.

A derotative incision is a simple and accurate technique in the adductovarus of the fifth toe.
I use to check the articular function and the exostosis size. If I find a normal or good articular function I only perform the exostectomy procedure, but If after derotation I find a rigid claw toe as Nellermoe says I will perform the arthroplasty. Arthroplasty of the 5th toe is in my opinion a great technique for this small and a lot of times sneaky and complicate toe.

Conclusion: In my opinion after continuous unsuccesful debridation a good option is silicone orthosis. When everything fails...Surgical treatment by derotative incision (if adductovarus is present), articular check and depending results simple exostectomy or arthroplasty.

I hope to be helpful :)