Lesser Toe Surgery

What is Lesser Toe Surgery?

Lesser toe surgery is an operation to correct deformities of the lesser toes other than the big toe. Some of the common lesser toe deformities include hammer toe, claw toe, and mallet toe.

Anatomy of the Foot

Anatomically, the foot is divided into the forefoot, mid foot and hind foot. The forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Phalanges have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The mid foot and hind foot have different structures, which are responsible for bearing body weight and performing activities such as walking and running.

Indications for the Surgery

Lesser toe surgery is recommended when non-surgical treatments fail to resolve the deformities of the lesser toe. Some of the common indications for the procedure include:

• Painful deformities of the lesser toe
• Pressure in the balls of the feet
• Pressure under the tip of the toe
• Pressure on the corns on top of the toes
• Difficulty walking and wearing shoes
• Callus formation and swelling in the joints

Preparation for Surgery

Your surgeon will brief you about the pre-surgery protocols and instruct you to do the following as necessary:

• Attend a preoperative assessment appointment 2-6 weeks before your surgery.
• Stop taking anti-inflammatory medications seven days prior to the procedure.
• Arrange a driver to take you home after the procedure.
• Arrange a caregiver to help you at home after the surgery.

How is Lesser Toe Surgery Performed?

The choice of operation depends on the type and severity of the deformity. The surgery is performed under local or general anesthesia. The surgical options include:

Modified “Oxford” procedure: This procedure is employed when your lesser toe is fixed in position and is painful at the top or tip.

• A cut is made at the base of the toe and the tendon on the top is lengthened.
• The joint at the base of your toe is freed.
• An incision is made in the first joint of the toe and a small piece of bone is removed.
• The joints and tendons are stitched up and the toe is splinted.

Modified “Stainsby” procedure: This procedure is performed when your toe is fixed in position and is painful on the ball of the foot and the top of the toe.

• A cut is made at the base of the toe and the joint at the base is freed up.
• Some bone is removed from the joint and the tight ligaments are freed.
• The tendons are stitched, and the toe is stabilized with a pin at the tip.
• The cut is then stitched up and a dressing is applied.

Toe fusion (arthrodesis) procedure: This type of procedure is used when your toe is deformed at the last joint with pain at the end of the toe, but the rest of the toe is pain-free.

• A cut is made across the joint at the toe tip and a small piece of bone is removed.
• The cartilage at the end of the toe bones in the middle joint is also removed.
• The toe is then stabilized with a pin at the tip of the toe.
• Bony surfaces are fused with pins or screws or wires.

Tendon transfer procedure: This procedure is usually performed in younger patients when the toe is completely mobile, and the deformity is correctable.

• A cut is made along the top of the toe and the tendon at the top is lengthened.
• Two small cuts are made on the bottom of the toe and the bottom tendon is released.
• The tendon is split in two and passed through the cut on the top of the toe.
• The tendon and the skin are stitched up and the toe is splinted with steristrips.

Postoperative Care and Instructions

As you recover, you are advised to:

• Keep the dressings on the foot until it is removed 2 weeks post surgery.
• Keep the wounds and dressing clean and dry until the wounds are thoroughly healed.
• Rest your foot completely for 2-4 days.
• Keep your foot elevated as much as possible for the first couple of weeks.
• Keep your foot dry at all times.
• Bear your weight through the heel.
• Adhere to prescribed pain medications.
• Adhere to instructions on diet, incision site care, bathing, and driving.
• Adhere to scheduled follow-up appointments to monitor your progress.

Risks and Complications

Some of the common risks and complications of lesser toe surgery include:

• Toe stiffness
• Injury to nerves and vessels
• Persistent swelling
• Infection
• Blood clots
• Bleeding
• Numbness or loss of sensation
• Non-union of bones
• Recurrence of deformity
• Reaction to the anesthesia
• Possibility of revision surgery

Benefits of Lesser Toe Surgery

Potential benefits of lesser toe surgery include:

• Reduced misalignment, pain and deformity
• Less or no formation of callus or corn
• Improved and near normal functionality of the lesser toe