Clawed and Bent Small Toes

This page describes the condition of clawed and bent small toes and the procedure of toe corrective surgery as performed by Mr Bowyer, at the Wessex Nuffield Hospital. Other surgeons may use variations on the technique, for instance with regard to post-operative management. It is important that you understand what your own operating surgeon intends to do, and how you will be treated after the procedure.

Description

It is not uncommon for toes, especially the second toe, to become bent or “clawed”. This problem can cause pain under the tip of the toes, under the balls of the feet, as well as corns on the top of the toes.

Non-Surgical Treatment

As much of the pain in such problems is caused by rubbing of shoes on the toes wearing shoes with a deep toe-box may alleviate symptoms. Toes can also be padded using foam or soft splints, and some problems respond well to taping. Corns can be treated by chiropodists.

Surgical Treatment

When footwear alterations, padding or chiropody do not help surgery may be indicated. Surgery is usually performed under a general anaesthetic, often as a day case or with just an overnight stay in hospital.

Surgery comprises correction of the toe deformity. This might involve removing one of the toe joints (excision arthroplasty) or realigning the bones (osteotomy such as Weil’s osteotomy). Small incisions will be made over the affected joint or at the base of the toes to be corrected. Through these incisions the surgeons will correct the bones or lengthen the soft tissues of the toe, to allow it to be brought down. The bone might then be cut to allow the toe to be straightened, and usually held in it’s new position with a small screw (which usually remains in the toe for ever), or with a wire going in from the tip of the toe (which is usually simply removed in outpatient clinic about 4 weeks after the operation). The wounds will be sutured, and the toes bandaged in a special way to help maintain the new position.

Surgical Aftercare & Recovery

Following your operation you should sit with your leg elevated on pillows to help decrease the swelling. You will be able to walk around, but it is important to keep the foot up as much as possible when you are sitting and resting, particularly in the first week or so after surgery. The toes will be sore, but should not be very painful. You will be given a special shoe to wear to protect the foot for approx 4 weeks, and a physiotherapist will show you how to walk using crutches.

You will be seen in clinic to have your stitches removed approximately 2 weeks after your surgery. After about 4 weeks you may begin to gently mobilise the toes as instructed at your clinic appointment. You will also be given advise with regards to weaning yourself into normal shoes, and resuming normal activity.

Possible Complications

Most cases go smoothly and about 80-90% of cases are judged by patients to have been a success. There are, however, always risks of complication when doing any surgery. In bunion surgery these include the following:

• Failure to improve the position or symptoms
• Recurrent deformity, or stiffness of the toe
• Infection
• Injury to nerves (numb or hypersensitive toe)
• Bone not healing, or screws becoming prominent and requiring removal
• General surgical / anaesthetic complications such as blood clots

How do I know if I have a Complication?

• Many of the problems become obvious with time, however you should notify the hospital or a doctor if you get an increase in your pain or swelling after you go home which does not settle with rest, elevation and mild pain killers, as this may indicate an infection
• You will be seen in an outpatient clinic in the weeks following your surgery to enable your doctor to monitor your progress
• Infection