Indications Excision of metacarpal heads Distal metatarsal osteotomy Partial proximal phalangectomy Fusion of MTP joints Capsulotomy of MTP joints Tenotomy Neurectomy Positioning Supine on operating table with a bolster under the thigh to flex the knee and keep the foot plantigrade on the table Incision Make 2-3cm dorsolateral incision parallel to corresponding extensor tendons If 2 adjacent joints need to be exposed, make the incision between them Superficial Dissection Incise the deep facia in line with the incision Retract the extensor tendon to reveal the MTP joint Deep Dissection Perform transverse or longitudinal arthrotomy Retract the joint capsule to expose the MTP joint