Lesser Toe/Hammer-Claw-Mallet Toe
Procedure
IP Joint Arthroplasty or Fusion, soft tissue release.
Aims of surgery
To reduce pain and deformity.
To straighten the toe.
To reduce callous/corn formation.
Advantages of this operation
Reduces the instability/malalignment which is the cause of the deformity.
Specific risks of this operation
Recurrence of the deformity.
Toe may not touch the ground 10% (floating toe).Increased prominence of adjacent toes.
Weakness/lack of toe purchase.
Pins (where used) may become loose – necessitating early removal – impairing result.
Revision surgery is necessary in approximately 2% of patients.
Infection in <2%.
Prolonged swelling.
Operation time
Usually between 15–30 minutes.
Incision placement/stitches
Usually on top of the toe and with absorbable or standard stitches.
Procedure
A small piece of bone is removed from the small joint in the middle of your toe. Sometimes a wire is used to fuse the joint straight. If necessary, the joint at the base of the toe may be released and the tendon lengthened.
Fixation
A wire or internal screw may be used to stabilise the toe whilst it is healing and is generally left sticking out of the end of the toe. This will need to be removed in clinic.
Will I have plaster?
No. You will be provided with a special shoe.
Is this a day procedure?
Yes, you can usually go home the same day.
Estimated time off work
Between 1-6 weeks depending upon the type of work you do and whether you can work from home.
Indications for the procedure
Painful hammer claw mallet toe deformity.
Painful prominent joint.
Difficulty with shoe fit despite wearing sensible footwear.
Alternative treatments
Manage your symptoms by changing activity levels, using painkillers, altering footwear style. The use of toe protectors, regular podiatry visits.
More information
Speak with your consultant.
The operation can be performed comfortably under a local anaesthetic block, which is achieved by a series of injections around the ankle. You will be fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered local anaesthetic with sedation or general anaesthesia.
The operation takes about 15–30 minutes although you will be in the day surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post-operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.
Post-Operative Care
First 2 days after surgery
This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2 days.
You will be able to stand and take weight after the operation, but you must rest, with your feet up, as much as possible.
You should restrict your walking to going to the bathroom.
You can get about a little more after 3 days.
3-14 days after surgery
You can be up and on your feet for up to 20 minutes/hour. You should sit and elevate your foot/feet for the remaining 40 minutes/hour at hip level.
You will need to attend for your foot to be checked and redressed.
Between 2–4 weeks after surgery
Any pin(s) will be removed during this period.
The toe(s) will still be quite swollen, especially at the end of the day.
You will not need a bandage any longer and can get the foot wet.
You will require a review appointment at 4 weeks.
Between 4–8 weeks after surgery
The foot should continue to improve and begin to feel normal again.
There will be less swelling.
Sport can be considered depending on your recovery.
6 months after surgery
You will have a final review between 3–6 months following surgery.
The swelling should now be slight and you should be getting the full benefit of the surgery.
12 months after surgery
The foot has stopped improving with all healing complete.
Please note, if a complication arises, recovery may be delayed.