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abducted toe surgery suggestions

Can someone give me some advice on surgery for abducted 2nd and 3rd
toes? I tried a Reverdin on the 2nd toe, but it did not solve the problem.
What would you recommend on the 3rd toe? I was thinking of performing
a Weil Osteotomy and pivoting the 3rd head to a more medial position.

The toes form a "V" when patient is weight-bearing. Any suggestions would
be greatly appreciated. She is scheduled for surgery very soon.

 

i usually approach these with a" reverdin like," osteotomy.however,i make a more narrow cut using a burr(open surgery) and leaving a hinge which i then "green stick,"(turn the digit towards the direction of the deformity and then return it towards the direction of the osteotomy until it breaks).i then fixate with a .035 k-wire,which i leave in for 4-6 weeks.furthermore i will perform capsulotomies,flexor and extensor tenetomies as needed in order to achieve the best possible reduction.
if for whatever reason is still see i can't achieve an ideal alignment.i will then consider a v-y skin pasty.however,i find that these should always be done as supplemental to the above mentioned procedures, not as a substitute as is frequently mentioned in the literature.
i hope this is of assistance to you.

 

I believe these are due to intrinsic muscular imbalances, and are best left untreated. They are mostly if not completely a cosmetic complaint. If surgery was necessary, I would free up all soft tissue atachments to the base of the proximal phalanx, place a .045 K-wire across the joint, and allow it to fibrose for 6 weeks.

I don't see how 'mini-reverdins' is the answer. There is not an angular deviation of the base of the proximal phalanx nor the head of the metatarsal, in the cases I have seen.