Lesser toe surgery
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What are lesser toe deformities?
When we discuss the lesser toes, we mean all of the toes other than the big toes, so you normaly have eight lesser toes. Many problems can occur and will often result in pain, blistering or rubbing, corns, callus, nial problems, and even ulcertion.
Toe deformities can occur due to injury, footwear, for hereditory reasons, or due to medical conditions such as rheumatoid arthritis, diabetes or neurological conditions.
The lesser toes are each made of three small bones so therefore each have two joints connecting these bones.
- Clawed toes – both of these joints are bent down, causing the toes to claw over. Most common on the middle three toes.
- Curled toes – one or both of the joints turn in, causing the toes to curl in towards the big toes. Most common on the fourth and fifth toes.
- Hammer toes – The first joint is bent down and the 2nd joint is straight or bent up, most common in the toe nex to the big toe (2nd toe).
- Mallet toe – The first joint is straight but the 2nd joint is bent down, most common on middle three toes, but usually the 2nd toe.
- Retraction of toes – The tendons on the tops of the feet are usually tight, pulling the toes up. This is often accompanied with clwing of the toes as the tips of the toes try to touh the ground when walking and standing. This deformity involved the metatarsophalangeal joints too which are the joints that attach the toes to the long metatarsal bones of the feet)
- Pre dislocation subluxation and dislocation – varying forms of joint instability where the joints can become loose and the toes can become floppy and float up, or cross over other toes.
Your podiatrist or surgeon should have offered the following things before surgery is considered:
- Alteration of footwear – wider/softer/deeper shoes
- Orthoses to make the foot more comfortable and attempt to affect the position of the toe joints if appropriate
- Use of medication to reduce pain levels
- Padding and offloading to reduce pain from the toe deformity
- The use of taping / strapping
The aim of surgery is to correct the bony prominence at the top (dorsum) or the end of the toe (apex). They may also need to alter the lengths of the tendons to improve the end result. If you have damage to the ligament that attaches to the bottom of the toe (plantar plate), then surgery to repair this may also be needed.
Lesser toe surgery ideally is done under local anaesthetic (with or without sedation) but in some cases general anaestheisa may be used.
You will have a small incision to the site of the deformity and often the surgeons will use either screws or wires to fix the bones into place. These are often removed later. There are new fixation methods being tested all the time. Your surgeon will be able to discuss these with you if they are relevant to your case.
They will use dissolvable stitches if possible and on average you will require 6 weeks off work but full recovery can take longer.
Of course with all surgery there are risks. The most common risks we may see with lesser toe surgery are:
- stiffness in the joint
- pain elsewhere in the foot as the forces have been altered
- elevated or malaligned toe
- the deformity may return if the fixation fails
- Post operative infection
- Delayed healing
- Pain associated with possible scar tissue
- Nerve damage