Foot surgery for toe problems

Toes are the digits in your foot and are associated with walking, providing balance, weight-bearing and other activities. Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis affecting bones and tissues of the foot. Toe deformities not only affect the alignment of the bones, joints and tissues in the foot, but may also affect alignment of the weight bearing joints such as the hips or knees resulting in further problems. The most common toe deformities are hammertoes, claw toes, and mallet toes.

  • Hammertoe: Hammertoe is a deformity in which there is downward bending of the middle joint of the toe or the proximal interphalangeal joint (PIP). Although it can affect the other toes, it most commonly affects the second toe. It may be present at birth or may result from wearing shoes that are too tight which forces the toe to bend forward. It may not cause any symptoms or require specific treatment unless the deformity becomes rigid, painful or develop corns and calluses. Hammer toe can be treated by ensuring that your child wears well-fitting shoes that has enough space for the toes to stretch.
  • Mallet Toe: Mallet toe refers to the downward bending of the third joint or distal interphalangeal joint (DIP) giving it a mallet-like appearance. Corns or calluses may develop over the deformity as a result of constant friction against the footwear. Mallet toe can be inherited or may develop from wearing shoes that are too tight or high-heeled.
  • Claw Toe: Claw toe is a rare deformity but occurs in association with cavus foot, Charcot-Marie-Tooth disease or myelomeningocele. It affects all the toe joints and results from hyperextension of the metatarsophalengeal (MTP joint or 1st joint) and flexion at the PIP (2nd joint), and DIP (3rd joint) joints. It results from altered structural anatomy and /or neurologic disorder that cause muscle imbalances.

Initially, toe deformities are treated by conservative treatment measures to restore or maintain walking ability, relieve pain, and also to delay progression of the deformity.

Surgical treatment is recommended if conservative treatment fails to relieve symptoms, or the deformed toes become rigid and immovable. The main objective of the surgery is to restore normal toe alignment and return the foot to normal pain-free function.

The surgical procedure is chosen based on the stability of the deformed toe, whether it is flexible or not. If some flexibility exists in the toe, then the surgeon will make an incision over the deformed toe joint and realign the tendons and ligaments. Pins may be placed to keep the toe in position while healing. The incision is then closed with sutures and covered with a sterile dressing.

In cases where the deformity is rigidly fixed, then the surgeon will make an incision over the joint of the deformity, realign the tendons and ligaments, and also perform an osteotomy, removal of bone pieces. Pins are also inserted to keep the toes aligned while healing. Finally, the incision will be closed with sutures and covered with a sterile dressing.

The Royal College of Surgeons of EnglandBritish Orthopaedic AssociationBritish Orthopaedic Foot and Ankle
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