Toe Surgery


 

Toe Problems

Toe problems are divided into 3 main toe deformities. These include a hammer toe, claw toe, or a mallet toe. In all these deformities, the toe becomes buckled, contracted or crooked at different joints. The toe could even cross over an adjacent toe, which is called a cross over toe. Any of the toes may be affected, but the 2nd and 5th toe are most commonly involved.

Symptoms

Patients with these toe deformities may develop pain on the top of the toe(s), tip of the toe, and/or on the ball of the foot. Increasing pressure from shoes may result in the formation of thickened skin (corn or callus) on the knuckle and/or ball of the foot. The toe(s) may become irritated, red, warm, and/or swollen. The pain may be dull and mild or severe and sharp. Pain is often made worse by shoes, especially shoes that crowd the toes. While some toe problems may result in significant pain, others may not be painful at all. Painful toes can prevent you from wearing  shoes.

When to Seek Treatment

Toe deformities come in varying degrees of severity – from slight to severe. The deformities can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.

 

Conservative Treatments

Non-surgical methods for hammer toes  are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger problem. These include, wider shoes, padding, strapping, moisturizing to decrease friction, foot orthotics, corticosteroid injections, oral anti-inflammatory medication. 

Surgical Intervention

Hammer toe surgery should most often involves removing a portion of bone within the toe joint, to reduce the joint contracture. 

There are generally two methods surgeons use to correct hammer toes – the procedures include either joint resection (arthroplasty) or "joint freezing" (fusion) procedures. Depending on where the contracture is present dictates where these procedures are performed. In addition to these procedures the toe might need soft tissue augmentation to release further contractures.  At times repair of ligaments(plantar plate) is needed at the ball of the foot if the ligament is damaged. 

Recovery

Recovery after hammer toe surgery generally depends on the method of surgery performed. In most cases, healing takes an average of 6 weeks in healthy people. Return back to regular shoes depends on level of activity that is required by the patient.   Simple toe surgery can recover very quickly, and return to a shoe in two weeks. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

 

 

Before Surgery

The big toe was pushing the 2nd and 3rd toe over and causing a deformity

After Surgical Correction

The big toe was straightened, and a joint freezing procedure was done at the distal joints, using a absorbable pin as fixation, which will dissolve in a couple of years.

 

 Frequently Asked Questions

 

How Soon Can I Walk After Hammer Toe Surgery?

At Localfootdoc, Dr. Majdanski's patients start walking immediately, the day of surgery, with the use of a surgical shoe.  Use of a cane or crutches is optional and is not necessary. Returning back to regular shoes is dependent on the type of procedure that the surgeon chooses to properly address the toe deformity. 

What Are The Risks Of Hammer Toe Surgery?

Hammer toe surgery risks include, but are not limited to: swelling, pain, infection,  bleeding, blood clot, poor wound healing, development of wound due to incision breakdown, poor bone healing (delayed union, nonunion), nerve injury, disability, floppy toe, reccurrance of the toe deformity, scar formation, pain on the ball of the foot, stiffness, shortening and weakness of the toe, breakdown of hardware, need for more surgery, and/or catastrophic loss, such as loss of toe, foot, leg, life. Although all these risk have a very low chance of happening, each person undergoing surgery should be aware of the risks. 

Complications may occur and are not necessarily your fault, or the fault of your surgeon.  

What Type of Anesthesia is Needed for Hammer Toe Surgery?

Hammer toe surgery is performed as an ambulatory surgery, and the patient gets to go home on the same day. Typically it takes about 20 minutes to perform a simple hammer toe procedure, per toe, and the patient may be able to go home right after the procedure depending on the length of time that is need to recover from the anesthesia.  The surgery can be performed under local, regional, spinal or general anesthesia. Local anesthesia , with sedation(monitored anesthesia care) is the most commonly used technique. This includes the use of medications by the anesthesiologist that relax the patient, while the surgeon numbs the foot with local anesthetic.  Lidocaine(same type of numbing medicine used at the dentist) is typically used to numb the foot.   Thanks to the medications used by the anesthesiologist, the patient doesn't feel any pain while the surgeon numbs the foot. 

 

What Causes the Corn on Top of the Toe and What Can be Done About it?

When a corn (thickened skin on top of the toe) is present, it is a cause of the underlying prominent bone rubbing against the shoe.  When surgery is performed and the underlying bone is removed, this will also correct the corn buildup. 

Will I Have Pain After Toe Surgery?

Patients typically experience mild to moderate pain, depending on each individuals pain threshold. Dr. Majdanski typically administers a post-operative injection which allows the foot to be pain free for up to 7 hours after surgery. In addition to the injection,  pain medication is prescribed to aid with pain management during the recovery process. 

How Should I Prepare for Surgery?

Weeks before surgery: Visit your primary doctor to obtain blood work and clearance for the surgery, if necessary. 

Days before surgery: Practice using crutches. Stock the refrigerator and pantry. Buy a "cast protector"(to avoid wetting foot during showers). Purchase ice packs. Supplement nutritional intake that will aid healing. 

Day before surgery: Fill pain medication and antibiotic prescriptions. 

Night before the surgery: Don't eat or drink anything after midnight. (unless instructed otherwise). Cleanse foot with soap and water(antimicrobial soaps are recommended). Relax and get a good night sleep. 

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