Hammer / Mallet / Claw Toes
Overview
The toes can undergo many types of deformities, usually because of an imbalance of the muscle activity in the foot. Lots of toe deformities can be accommodated in wide fitting, deep toe box shoes. Likewise, your local chemist will stock many devices such as hammer toe straps, corn plasters, bunion spacers, metatarsal dome lifts etc. If your deformity becomes painful and is significantly limiting your choice of footwear, there may be a role for surgical intervention.
Non-Surgical Treatments
Deformities of the lesser toes can typically be managed without surgical intervention. Remember – it is easier to change your shoe than your foot!
Most patients will respond well to simple interventions, such as changing your shoes to deep toe box, wide fitting shoes. Existing shoes can be stretched by your cobbler. There is no harm wearing a fashion shoe for special occasions (“car to bar shoes”) but bring your comfortable shoes with you for later. Silicone sleeve devices can slide onto your toes like a glove and avoid friction. Spacer devices can offer great relief, however the ‘over the counter’ devices are designed for everyone, but fit no-one, so I suggest attending a trained Orthotist to have customised spacer devices made for you. Physiotherapy guided foot muscle strengthening and stretching exercises are important to avoid progression of your toe deformities.
Surgical Treatments
Surgical correction of lesser toe deformity is indicated when you have significant pain and disability, despite exhausting the non-surgical treatments. The surgery is performed as a day-case procedure, with you under a General Anaesthetic. I numb your foot (“an ankle block”), so when you wake up, you should be very comfortable.
The surgery involves release tight soft tissues, removing proud pieces of bone and holding the toe straight with a wire. Your foot will be dressed and you will see a ball at the tip of your toe, covering the wire. You may put your weight through your heel after the surgery and we give you a special post-op shoe and crutches, before you go home. FOOT ELEVATION is really important until the toe has healed, so while you make walk about, please limit your walking until the wire is removed after 6 weeks. You cannot drive while the wire is on your toe.
I see you again 2 weeks after the surgery to check the wound and re-dress your foot and again at 6 weeks with new x-rays. If all looks good, I then slide out the wire in the office, so no further anaesthetics are needed. Once the wire is out, you can return to all activities, but it does take another 6 weeks to return to all activities.
Complications with Lesser Toe Surgery include infection, wire loosening and back-out, recurrence of the deformity, leg clots that can travel to the lungs, pain and prolonged swelling.
Surgery – What to expect?
The surgery should straighten your toe, so you can fit comfortably in a shoe. You can expect toe swelling for a minimum of 3 months after surgery, but the swelling typically lasts for up to one year. Most patients have returned to regular walking and activities 3 months after their surgery. Recurrence can occur in the years after the surgery.
