Vertical dorsal incisions were made over the first metatarsophalangeal joint between the second and third metatarsal heads and between the 4th and 5th metatarsal heads. A resection arthroplasty was performed of the second, third, fourth, and fifth metatarsal heards in a cascading pattern from medial to lateral. Sagittal saw was used to resect the head of the first metatarsal and the base of the proximal phalanx in order to prepare for fusion. It was provisionall pinned with K-wires and definitive stabilization was obtained using an OrthoHelix MaxLock Extreme first metatarsophalangeal arthrodesis plate. A combination of regular cortical screws and locking screws were used. Vertical incisions were made over the 2nd, 3rd, 4th, and 5th proximal interphalangeal joints of the less toes. A resection arthroplasty was performed by removing 2 mm of the head of the proximal phalanx and 1 mm at the base of the middle phalanx. this was done in each of the lesser toes. In addition, extensor and flexor digitorum long tenotimes were performed at each of the lesser toes. It should be noted that there was an ulceration on the dorsal lateral aspect of the hardware and all was noted to be satisfactor. The wounds were thoroughly irrigated prior to closure. A 0 Vicryl was used to close the capsule of the 1st MTP joint.