Lesser toe surgery

Mallet toe surgery, Claw toe surgery
Summary

This operation is performed for symptoms affecting the lesser toes of the foot.  There are a number of deformities that can occur to the lesser toes such as “hammer”, “mallet” or “clawing”.  These are often associated with bunions affecting the big toe.  The deformities can lead to rubbing of the toes when wearing footwear.  Occasionally a toe (normally the 2nd) will be “overcrowded” causing it to override the other toes.  Surgery involves correcting the deformities through bony, soft tissue or a combined procedure.  

Factors to Consider

You have been diagnosed with a deformity to the lesser toe(s).  It is likely that you have already tried non-surgical treatments for your foot such as pain killers, footwear modification and orthotics.  

If these measures have not improved your symptoms then the next logical step is to consider surgery.  Lesser toe surgery with or withour bunion surgery can help restore your foot to a more cosmetic appearance as well as reduce the symptoms associated with the deformity.

Description of Surgery

The operation can be performed as an open procedure or through a minimally invasive approach.  Surgery will vary between each patient depending on how severe the deformity is and whether arthritis is also present.  The principles of the surgery are to balance the soft tissues around each toe to allow the toe to sit in a normal position.  This may involve removing some bone or fusing one of the small joints to the toe and releasing or lengthening the tendons around the toe.  It is common for a combined approach to be used.  In order to keep the toe in a corrected position a metal wire can be passed down through the tip of the toe.  This is removed 4-6 weeks following surgery. 

Hallux valgus surgery may need to be performed if the big toe is involved in the deformity. This is commonly done at the same time.  In very severe deformities, an amputation of one of the toes can be considered.

The operation takes about 1 hour.

Anaesthetic

The operation is usually performed under a general or spinal anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  Lesser toe surgery aims to improve the function and the appearance of the foot.  Patients will have varying expectations of surgery and it is important to know that the majority, 80-85%, are satisfied with the outcome.  

The toes can feel weaker after surgery and this can cause a transfer of pressure onto the ball of the foot causing pain.  This is known as metatarsalgia.  Correcting the deformity can be challenging and in some patients the deformity will recur.  

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a bandage with a heel weight bearing shoe.  This is a shoe that only allows you to put weight through the heel, thus protecting the surgery.  You may also have metal wires visible at the tip of each toe.  This is normal and is holding the toes in the new, corrected position.  Your surgeon will arrange to remove these around 4-6 weeks following surgery. 

 It is likely that you will need a heel weight bearing shoe for the first 6 weeks.  The surgeon will give you instructions as to when you can start to fully weight bear.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you once you are fully weight bearing.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 6 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 12 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.