Lesser toe deformities are common and often cause pain and limitation of function and problems with shoewear.
Deformities often start out as flexible able to be straightened and then become stiff and not correctable.
Common deformities include:
- Mallet toes
- Hammer toes
- Claw toes
- Under or over riding toes
- Splaying of toes
What are the symptoms?
- Pain or irritation in shoes due to rubbing causing areas of red inflamed skin or blisters
- Development of corns or callous over the tip of the toe, top of the toe or the ball of the foot dependent on the type of deformity
What are the causes?
There are many causes but the commonest are
- Secondary to a bunion deformity
- Plantar plate pathology
- Neurologoical conditions
- Inherited or congenital deformity
- Tight shoes
- In some cases there is no clear cause
Mallet toes involve the joint at the end of the the toe, the DIP joint which is flexed. This often causes pain and callous on the tip of the toe.
The middle joint ( PIP joint ) of the toe is bent.
Patients are aware of rubbing over the top of this joint but may also have pain and callous on the ball of the foot beneath the toe
This type of deformity is commonly seen in association with a bunion
The first joint ( metatarsophalangeal joint or MTP joint ) is extended and the next two joints ( PIP and DIP joints )are flexed.
Patients often have pain and callous on the ball of the foot, on the top of the second joint
( PIP joint ) and on the tip of the toe.
This type of deformity is often seen in cavovarus foot shapes and in patients with conditions affecting the nerves.
What is the non surgical treatment?
Non surgical treatment focuses on offloading the areas which are rubbing on shoes or are causing pain due to pressure.
This is achieved by:
- Callous removal by podiatrist
- Silicon toe sleeves
- Reducing pressure with orthotics
- Metatarsal dome / bar
- Toe spacers
When the treatments above do not resolve the symptoms the next step is surgery.
What does surgery involve?
- Flexible deformity- tendon release
- Fixed deformity – DIP joint fusion with a screw
Hammer toes and Claw toes
Surgery for these deformities is similar.
The choice is determined by the site of pain and callous and the severity of the deformity.
A combination of procedures may be required and may include:
- Extensor tendon lengthening
- Soft tissue release of the MTP joint
- Fusion of the PIP
- Fusion of both PIP and DIP joint
- Minimally invasive osteotomy of the toe
- Shortening of the metatarsal
- Plantar plate advancement
What implants are used?
- Intramedullary implant
- Wires which sit outside of the toe for 6 weeks
What does the rehabilitation involve?
- Day surgery for isolated toes
- 1 night in hospital for multiple toes
- Elevation and rest for 2 weeks
- Weightbearing as tolerated in a post operative shoe which is worn for 6 weeks.
- Review at 2 weeks for suture removal.
- Removal of wires if used at 6 weeks
- Physiotherapy to assist maintenance of correction and joint motion.
- By 6 weeks managing activities around the house.
- By 3 months back to recreational walking
- Final result with resolution of swelling 6-9 months.
How long will I be off work?
This is dependent upon your occupation
- Seated job 2 weeks
- Standing job 4-6 weeks
- Heavy lifting job 12 weeks
When can I drive?
- Manual car
- No driving for 6 weeks
- Automatic car
- Left foot no driving for 2 weeks
- Right foot no driving for 4 weeks
What are the risks of the procedure?
General risks of surgery
- Wound healing problems
- Nerve injury and scar sensitivity
- Blood clots to the leg
- Anaesthetic problems
Specific risks for lesser toe surgery
- Incomplete pain relief
- Persistent swelling of toe or foot
- Early pull out of the wire
- Non union of fusion and implant failure
- Incomplete correction of deformity
- Recurrence of deformity
- 10% chance of requiring further surgical correction
- Loss of blood supply to toe resulting in partial or complete toe amputation (rare)
This information is an overview of the management of lesser toe deformity and is not all inclusive.
If you have any questions please contact Mr Curry’s rooms on (03) 99286560