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Lesser toe surgery

Hammer toe surgery covers the majority of procedures for the treatment of conditions of the lesser toes.

Most people with hammer toes obtain relief from pain with shoe modifications or by using orthotics in shoes.  If a patient has ongoing symptoms despite non-surgical treatment, then surgery can be considered.

The actual procedure will depend on the type and extent of the toe deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. Patients will be able to walk, but should not plan any long hikes while the toe heals, and should keep the foot elevated as much as possible.

Who Requires Surgery?

Surgery is only required if a Hammer toe is symptomatic. Although hammer toes often get less flexible over time, surgery is not recommended to prevent the deformity from worsening. Proper shoes and other simple measures can slow the progression of hammer toes, and prevent them from becoming symptomatic.

Cosmetic appearance is not a recommended indication for surgery. It is possible for the toe to become painful after surgery, even if it was not painful prior to surgery.

Indications for hammer toe surgery include:

  • Difficulty with daily activities and wearing shoes due to pain in their toes.
  • Significant pain in their foot while walking.
  • Rest and/or medications fail to improve the inflammation in the toe(s).
  • Toe deformity – deformity of one toe can lead to deformity of another toe or crossover toe.
  • Toe stiffness – where the toe has lost it flexibility. Stiffness alone would not be an indication for surgery.
  • Ongoing symptoms in their toes despite shoe modifications.
  • Significant pain even with regular use of paracetamol AND / OR non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. People may have different response to the same pain relief.

Surgical Procedures

Most lesser toe surgeries involve:

  • Shortening the metatarsal (MT)
  • Realigning the metatarsophalangeal (MTP) joint at the base of the toe
  • Bony and soft tissue procedures to correct the deformity of the toe itself

The aim of these procedures is the relief of pain and greater ease in fitting shoes.
Depending on the deformity, different surgical procedures can be performed to correct the deformity.  In most cases, a combination of bony realignment and soft tissue balancing will be required during surgery.

The appropriate type of surgery will be discussed by your surgeon during your consultation.

Balancing the Tendons and Ligaments Around the Toe

In most cases, there is a soft tissue imbalance around the toe that is driving the deformity of the toe.

Surgery can be performed to tighten the lax tissues, lengthen the tighter ones.  In most cases, balancing the soft tissue is only a part of the entire procedure. 

Osteotomy

An osteotomy is a cut in the bone to realign the bone/ joint with a view to correcting the overall toe deformity.  In some case the bone is fixed with screws/wires as required. Some bony cuts do not require fixation.  The overall effect is to have a straighter toe with balanced joints.

Osteotomies are usually performed in combination with soft tissue balancing to achieve and maintain toe alignment.

Arthrodesis

In this procedure, the surgeon removes the arthritic/stiff joint surfaces, then inserts screws or wires to hold the surfaces together until the bones heal. Arthrodesis is commonly used to correct rigid hammer toe deformities and is performed in the middle and/or distal joints of the toe.

Correction of 2nd and 3rd toe deformities.

Surgical complications

Foot surgery is associated with risks (complications), same as any other surgery.  Complications occur infrequently and are usually treatable, in some cases, they may lengthen or prevent full recovery. Your surgeon will discuss the risks of the surgery with the patient.

The possible risks and complications of toe surgery include:

  • Infection
  • Nerve damage
  • Persistent pain
  • Failure of toe fusing
  • Stiffness of the toe joint
  • Recurrence of the toe deformity
  • DVT

Recovery at Home

It is important to follow the surgeon’s instructions at home during the first few weeks after surgery.  This will directly affect the surgical outcome.

Dressing Care

On discharge from the hospital the patient will have bandages holding the toe in its corrected position. It is important to leave the dressings intact. Do not disturb or change the dressing without talking to the surgeon. Interfering with the dressing could cause a recurrence of the deformity.

The wound and dressing must be kept dry. The foot must be covered with a firmly taped plastic bag while showering or bathing.

If sutures are present they will be removed about 2 weeks after surgery. In some cases, continued support from a dressing or brace may be required for up to six weeks.

Medications

Patients will be given a prescription to improve the surgical discomfort. Some pain medications can be addictive and should be used only as directed by the surgeon.

Once the pain diminishes stop taking Opioid medications and take simple analgesics such as Panadol as required. If you are concerned about the severity of pain, please contact the KOG rooms.

Swelling

Keep the foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by the surgeon to relieve swelling and pain. Never apply ice directly on the skin. It is common to have some swelling in the foot for three months after toe surgery.

Shoe Wear

It will take several months for the bones to fully heal. When the initial rehabilitation period is completed, the surgeon will advise on shoe wear. Athletic shoes or soft leather oxford type shoes will best protect the toe correction until the bones have completely healed.

To help prevent the toe deformity from recurring, fashion shoes must not be worn until the surgeon allows it. Be aware that the surgeon may recommend against wearing high-heeled shoes at all in the future.

Avoiding Complications

Though uncommon, complications can occur following toe surgery. During recovery at home, contact the surgeon if the dressing loosens, comes off, or gets wet.

Contact the surgeon immediately if the following occur.

  • the dressing is moistened with blood or drainage.
  • significant swelling in the calf above the treated foot.
  • shortness of breath.

Contact the surgeon immediately if any of the following warning signs of infection occur:

  • Persistent fever
  • Shaking chills
  • Persistent warmth or redness around the dressing
  • Increased or persistent pain, especially a "sunburn" type pain

Outcomes

Most patients who undergo toe surgery experience a reduction in pain, along with improvement of their toe deformity. Recovery from surgery will vary depending on the type of surgery and patient’s adherence to surgeon’s instructions.

Because toe deformities can be caused by poor choice of shoes, returning to that type of shoe can cause the toe deformity to return.

Hammer toe surgery covers the majority of procedures for the treatment of conditions of the lesser toes. 

Most people with hammer toes obtain relief from pain with simple treatments to reduce pressure, such as wearing wider shoes or using pads in the shoes. However, if these measures do not relieve symptoms, surgery may be recommended.

The actual procedure will depend on the type and extent of the toe deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. Patients will be able to walk, but should not plan any long hikes while the toe heals, and should keep the foot elevated as much as possible.