A dorsal longitudinal incision is centered over the metatarsophalangeal (MTP) joint or in the webspace if more than one hammertoe is being addressed.

First, identify the extensor digitorum longus (EDL) tendon and tenotomize as distal as possible. Next, identify the extensor digitorum brevis (EDB) and tenotomize as proximal as possible within the incision.

Use a scalpel to make a transverse incision in the MTP joint capsule to release the dorsal capsule. Release the capsule medially and laterally along the metatarsal head, taking care to avoid the neurovascular bundles. Use a McGlamry Elevator to release the plantar capsule.

Next, make a dorsal midline incision centered over the proximal interphalangeal (PIP) joint of the affected toe. Incise the extensor tendon in line with the incision and elevate subperiosteally medially and laterally to expose the joint. Release the collateral ligaments off the proximal phalanx.

Excise the distal aspect of the proximal phalanx using a microsagittal saw oriented perpendicular to the shaft. Use the microsagittal saw to remove the cartilage from the middle phalanx.

Use a small clamp to dissect plantarly and identify the three flexor tendons. Sequentially deliver each tendon, clamp, and then tenotomize on either side of the clamp to excise several millimeters of tendon.

Pin toe in place using retrograde technique.