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.1

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

Non-manual work approximately 4–6 weeks.
Manual work approximately 6–8 weeks.

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 2–4 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 2–4 days.
You will be able to stand and take weight carefully (using crutches) 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. When getting about use your crutches in the way you will have been shown.
You can get about a little more after 3 days.

1–2 weeks after surgery

You may need to attend for your foot to be checked and redressed.
You may start to do a little more within pain limits. Pain and swelling means you are doing too much.

Between 2–6 weeks after surgery

Any pin will be removed during this period.
The foot 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 may require a review appointment at 4–6 weeks.
You may return to work, but may need longer if you have an active job.
You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again.

Between 6–8 weeks after surgery

The foot should continue to improve and begin to feel normal again.
There will be less swelling.
Sport can be considered after 3 months 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