You have been directed to this section of the website because you have a deformity affecting one or more of your toes. Here, you will find details on how a toe deformity can be managed both surgically and non-surgically.
A toe deformity relates to an abnormally shaped toe, which is bent at one of its joints. This leaves the joint prominent and can cause footwear discomfort or rub on adjacent toes. Toe deformities often result in the formation of painful hard skin or corns over the affected joint. It may also lead to a damaged toenail.
A toe deformity is diagnosed by the examination of your foot. X-rays are not normally required but may be requested to rule out additional problems.
There are various types of toe deformities and these are named depending on where the deformity lies within the toe.
Note how the 5th toe rotates inward towards the other toes. This can lead to discomfort between the toes or on the outer edge of the 5th toe.
When the big toe is affected, this is referred to as a “trigger hallux” or hallux malleus. This can result in pain across the top of the toe where the joint is prominent.
• Wider/deeper fitting footwear
• Padding, toe props
• Routine podiatry treatment to remove painful skin lesions
There are many types of toe protectors. Those lined with silicone can be effective at protecting and cushioning a prominent joint
Surgical management of toe deformities is achieved by either removing a small section of the joint (arthroplasty) or by joining two of the bones in the toe together in a straight position (arthrodesis).
The photo above shows hammer 3rd and 4th toes undergoing an arthroplasty with the head of the proximal phalanx resected.
For an adductovrus toe deformity, the skin incision can be made in such a way that it rotates the toe into a straight position.
When the 1st toe is affected, an arthrodesis is performed.
The joint is removed by cutting the small bones in the toe then resetting the toe in a straight position. A wire is then used to hold the two bones together while they fuse. This runs through the middle of the toe and protrudes by approximately 5mm for a period of 6-weeks (see diagram below). It is then removed when you are reviewed in clinic. This is a painless procedure and does not require anaesthesia.
A protective shoe will be put onto your foot before you leave the hospital. This is removable and can be taken off when resting. Crutches are not normally required but will be provided when necessary.
You should travel home by car and keep your foot elevated on the back seat where possible. When you go home, you must rest with the leg elevated for the first 2-4 days (essential walking only). It is important that you do not interfere with the dressings and that you keep them dry. You can buy a purpose made waterproof device from the chemist if you wish.
Mr McCallum will review you within one week of your operation for a change of dressing and at the 2-week mark, the dressings will be removed and the sutures cut. You can wash your foot as normal and return to a comfortable shoe from this point onward.
If you have had an arthroplasty, it is safe for you to increase your activity levels to tolerance and treat the foot as normal. It can often take up to 6–months for the toe to entirely settle down.
If you have had an arthrodesis, Mr McCallum will review you 4-weeks later to remove the wire and after this, you can treat the foot as normal. It can often take 6-months for the toe to completely settle down.
Possible Complications following surgery:
Outlined below are the possible problems following foot surgery or the rare complications with serious outcomes. In cases where there are no accurate audit results, published results from podiatric literature have been used.
• Prolonged swelling taking more than 6-months to resolve can occur in 1 in 500 operations.
• Haematoma- a painful collection of blood under the skin. This can increase the risk of developing an infection and may require further surgery to resolve.
• Thick or sensitive scar.
• Adverse reaction to the post-operative pain killers. 1 in 50 patents report that codeine preparations make them feel sick.
• Infection of the soft tissue. 1 in every 83 operations.
• Infection of bone- osteomyelitis. This is a serious complication and in severe cases, can lead to amputation.
• Delayed healing of soft tissue or bone.
• Circulatory impairment with loss of tissue. This can result in amputation.
• Loss of sensation can occur although this is not normally permanent and can continue to improve over 18-months.
• Deep vein thrombosis (blood clot) can result in the clot travelling to the lung and this can be a life threatening condition. Deep vein thrombosis incidence is 3 in 1000 cases.
• Complex pain syndrome- a condition where the nervous system dealing with pain over reacts. This is a very painful condition that can result with even with minor trauma. It normally requires management by specialists in this condition and does not always resolve. This is a rare condition that occurs in 3 in 2500 cases.
• Recurrence of deformity or failure of the surgery.
Specific risks associated with toe surgery:
• Incomplete correction or recurrence of the deformity.
• Prolonged swelling of the toe.
• The toe may not touch the ground.
Specific risks to arthrodesis:
• The pin may come loose and require early removal. Very rarely it comes out by itself.
• The two bones may not fuse together. This is not always problematic however, if the toe remains painful or becomes misshapen again, further surgery may be required.
The risk of developing a complication can be minimised when the patient and all those concerned with the operation and aftercare work together. This starts with the pre-operative screening and continues through to the post-operative regime.
The pre-operative screening helps us determine whether you are fit for surgery or if any extra measures need to be considered to minimise your risk of developing a complication. It is important that you disclose your full medical history. If there is a query regarding your health then further investigations may be required and Mr McCallum will liaise with the appropriate medical specialists. Mr McCallum and the there team will ensure that your operation is carried out safely and effectively.
You can improve your healing process and reduce the risks by:
• Adhering to the post-operative instructions, which include resting and elevating the operated foot. Keeping the wound dry and clean until advised otherwise. Please ask Mr McCallum if you are not sure what to do.
• Having a healthy diet is important; this provides the nutrition required for healing.
• Smoking is associated with a 20% increased risk of delayed or non-healing of bone.
• Alcohol can interact with the drugs that are prescribed and can impair wound healing.
• Post-operative mobilisation will be advised; this helps improve flexibility, strength and stability of your foot.