New Option For Hammertoe Fixation

Until now, options for hammertoe fixation haven’t been ideal. Simply fusing the joint with a K-Wire alone is fast but often not effective. Intramedullary fixation, on the other hand, is time-consuming, complex, and expensive.

ExoToe™ offers a unique solution. It was the first extramedullary device of its kind that’s just 0.6 mm thin and preserves the bony canal.


ExoToe™ doesn’t require insertion into the intramedullary canal. It’s easy to size, place, and adjust to ensure an appropriate angle of fusion.

Competitive Advantages

Interoperative anatomic angle adjustability. Only interoperative adjustable implant that allows straight or customized angle adjustability

Extramedullary device that preserves medullary bone allowing ExoToe to be used as a primary hammertoe device or for hammertoe revision cases

Allows for K-Wire to be used in conjunction with the implant to stabilize the MTPJ

Easy to remove using a Mini-Hohmann

Provides rotational stability

Helpful Resources

Download the ExoToe Surgical Technique guide.

ExoToe™ was developed by Surgical Design Innovations. The team at Surgical Design Innovations have extensive experience in all levels of medical device development – including product development, early design prototyping, mechanical and cadaveric testing, and early clinical use.

“This is why I ExoToe! Easy to use. I was very happy with the outcome.”

Danielle Butto, DPM, FACFAS

“Loved it! Incredibly easy.”

Brett Sachs, DPM, FACFAS

“I love the ease of implanting ExoToe. I have confidence in the stability of the IPJ fusion site, even after removal of the K-Wire. It makes correcting MPJ contractures a cinch! “

Jill Frerichs, DPM, FACFAS

“Very easy to implant, and the stability at the fusion site is impressive.”

New Surgeon User

Coming Soon!

ExoClip™ will be available soon! Contact us to find a distributor in your area.

Surgical Technique

ExoToe doesn’t require insertion into the intramedullary canal. It’s easy to size, place, and adjust to ensure an appropriate angle of fusion.

Step 1

Joint Preparation

Prepare the PIPJ fusion site using standard surgical techniques. Make a linear dorsal incision over the proximal interphalangeal joint extending over the middle phalanx to the DIPJ. The extensor tendon is transected at the level of the PIPJ and elevated off the proximal and middle phalanges (alternatively the tendon can be left on the middle phalanx and the ExoToe implant applied over the tendon). Collateral ligaments are released at the PIPJ. Prepare the proximal and middle phalanges for fusion using surgeon preference*. The PIPJ fusion site is fixated with standard K-Wire with or without crossing the MTPJ.**

*Examples: End to end, cup and cone, “V”, etc.
**K-Wires not included

Step 2


Once alignment and fixation of the toe with the K-Wire is confirmed, determine the correct size of ExoToe implant to be used. Starting with the largest sizing template (7.5), place the template onto the bone and center it over the fusion site. The sizing template clears the bone when the dorsal aspect touches the bone and the proximal and distal cuffs do not touch the bone. If the template clears the bone, continue with the next smallest size until the template does not clear the bone. Select the ExoToe implant that corresponds with the smallest template that clears the bone.

*If the smallest template (5.5) clears the bone, assess the approximation. If excessive, do not proceed with implantation of the ExoToe implant.

Step 3

Implant Insertion

After selection of the correct ExoToe size, remove the ExoToe from the packaging and transfer to the sterile field. Hold the distal side of the tines with the Crimping Forceps. The points of the forceps engage corresponding holes on the ExoToe. Prior to crimping the ExoToe to the bone, ensure manual compression of the proximal and middle phalanx.

Step 4

Middle Phalanx Fixation

Center the ExoToe implant directly over the fusion site. Dorsal to plantar digital pressure is used to push the ExoToe down onto the fusion site. The forceps are then used to crimp the tines into the middle phalanx in order to secure the ExoToe to the bone.

*Alternatively, the crimping may be completed with a curved Kelly hemostat.

Step 5

Proximal Phalanx Fixation

Once the middle phalanx is crimped appropriately, the proximal portion is crimped to the proximal phalanx, making certain the ExoToe is held close to the bone with dorsal to plantar pressure during crimping. Proper fixation and engagement of the ExoToe to the bone segments is then confirmed.

*Surgeon discretion is used for removal of K-Wire. If control across the MTPJ is preferred, the K-Wire is left in place at the surgeons’ preference.

Wound Closure

Care should be taken to repair the extensor tendon over the implant. If the distal segment was crimped over the tendon, repair the proximal segment of the extensor tendon to the distal stump through the central window of the ExoToe.

Implant Removal

If the surgeon deems the ExoToe placement was unsuccessful, the implant may be removed by placing a Mini-Hohmann retractor into the crimping holes to pry both tines on the lateral side, then remove the implant medially. The staple may be replaced if desired. Removal of the implant is based on surgeon preference. The appropriateness of the selected procedure will be based on the surgeons’ personal medical training and experience.

3 Sizes To Choose From

Our sizing tool will help you select the right fit for each patient.

ExoToe™ is made of 316 Stainless Steel.
*Dimensions are rounded to the nearest tenth millimeter.

Contact Us

Ready to get ExoToe into your operating room? Get in touch today!


(515) 201-3723