LESSER TOE DEFORMITIES
HAMMERTOE / CLAW TOE / MALLET TOE
These are deformities of the lesser toes; which can be either flexible or rigid in nature. With hammertoe there is flexion at the joint closest to the balls of the feet, whilst mallet toe is flexion of the joint near the tip of the toe.
Claw toes are often associated with neurological disorders or inflammatory arthropathy.
Patients often develop pain from friction of the top of the toes in shoes, resulting in callus formation.
Changing foot wear to a wider shoe to give the foot space, as well as a taller toe box may be of relief.
Over-the-counter toe sleeves to protect the area of friction may also be utilised.
If the deformity is flexible and related to an elongated metatarsal, the metatarsal can be broken and shortened (osteotomy). This change in position is held secure with a small screw. In the situation where the metatarsal is not elongated, there are some soft tissue releases that can be performed to correct the position of the toe.
When the deformity is rigid, the joint affected can be excised and joint fused straight; this is held with a wire (that is removed in clinic after 5 weeks) or with an implant that stays within the bone.
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, non-union, under correction and over correction.
Your foot will be in bandaging and a surgical shoe will be provided
to allow you to weight-bear whilst protecting the foot. You will be provided with crutches for support. Elevation, as much as possible,
is important in the first few weeks. The bandaging will come down
at 2 weeks and dressings changed. If a surgical soft tissue release
has been performed only, and no wires have been used to hold the toe in position, you can go back to wearing comfortable shoes at
this stage. The surgical shoe will be required for weightbearing for approximately 5-6 weeks if a fusion procedure has been performed. Swelling can be expected to be present for up to 6 months, particularly in the evenings.
If a wire has been used to hold a fusion, this wire shall be removed in clinic at the 5-week stage and the skin would will need protecting for a further week.
With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 6-8 weeks