Hammer & Claw Toe Surgery and Toe Shortening Operation
What is it? This is an operation to correct deformities of the toes other than the big toe, usually "hammer" or "claw" toes. The operation described here is the commonest we do for these problems. It s used when the joint at the base of the toe is flexible but the joint in the toe itself is stiff - this is the usual situation. However, there are other operations for when either both joints are still flexible, or both are stiff. Why would it be done? If the deformity is painful, causes the toe to rub in the shoe or causes pressure in the ball of the foot, and cannot be accommodated in a shoe, surgery would be considered. Some people prefer to have shoes with extra depth and possibly an insole provided. Others do not like such shoes, or are not comfortable in them. What does it involve? A cut is made across the top of the toe. If several toes are operated on at the same time, each toe has its own cut. The joint in the middle of the toe is opened and some bone removed to allow correction of the deformity. The joint at the base of the toe may also need to be freed up through a cut on top of the foot. Occasionally one of the tendons from the underside of the toe is re-routed to the top of the toe to help keep it corrected. There is no need for a plaster. Can it be done as a day case operation? If you are medically fit, have someone who can collect you and look after you after the operation, and you are comfortable afterwards, the operation can be done on a day case basis.
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Will I have to go to sleep (general anaesthetic)? The operation can be done under general anaesthetic (asleep). Alternatively, an injection in the back, leg or around the ankle can be done to make the foot numb while the patient remains awake. Local anaesthetic injections do not always work and in that case you may have to go to sleep if the operation is to be done. Your anaesthetist will advise you about the best choice of anaesthetic for you. In addition, local anaesthetic may be injected into your leg or foot while you are asleep to reduce the pain after the operation even if you go to sleep for the surgery. You will also be given pain-killing tablets as required. Will I have a plaster on afterwards? No plaster is necessary if you are only having your toes straightened. Some people also have a bunion corrected, or an operation for arthritis of the big toe, at the same time. If so you may have a plaster shoe applied to protect the big toe. What will happen afterwards? The dressing on your foot can be removed two or three days after surgery and replaced with a simple adhesive dressing to cover the wound. You will be seen again about 10-14 days after surgery to check the wound and the toe. How soon can I.... Walk on the foot? You can walk on the foot immediately after surgery. The ball of the foot may be rather sore after the toe is straightened so you may wish to put most of your weight on your heel for the first week or two.. Go back to work? If your foot is comfortable, and you can keep your foot up and work with your foot in a special shoe, you can go back to work within a few days of surgery. On the other hand, in a manual job with a lot of dirt or dust around, you may need to take anything up to one months off work. How long you are off will depend on where your job fits between these two extremes. Drive? If you have only your left foot operated on and have an automatic car you can drive within a few days of the operation, when your foot is comfortable enough. Most people prefer to wait till the stitches are removed and they can wear a shoe. Play sport? After your stitches are removed you can start taking increasing exercise. Start with walking or cycling, building up to more vigorous exercise as comfort and flexibility permit. Most people can get back to their previous level of activity within 6-8 weeks of surgery What can go wrong? The commonest problem is that the toe can curl up again, usually to a much less severe degree then before. This occurs in about 5% of people, but only a few of these will have to have further surgery. Most people’s toes will be fairly swollen after the operation and settles down over the next few months.
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