Percutaneous treatment of lesser toe deformities (LTD) is rapidly gaining popularity due to the safe and effective results of percutaneous forefoot surgery. De Prado was the first to describe a percutaneous approach to LTD combining osteotomies, condylectomies, and selective tenotomies. Since then, many developments in surgical techniques have been described: selective tenotomies and unicortical or bicortical new osteotomies. This article aims to describe the main percutaneous soft tissue and osteotomy techniques, their results and indications. We propose a sequential therapeutic strategy from proximal to distal using decision trees based on the latest published studies and our own experience.