Surgery for Problems of the Small Toes Treatment

Introduction

The main goal of the Surgery for the problems of the small toes is to correct the deformity and prevent it from interrupting the patient’s day to day activities if simple measures haven’t been successful. The lesser toes can lead to a number of abnormal appearances and positions which includes: mallet toe, hammer toe, curly toe, and claw toe. Deformed small toes tend to rub on the shoes and may cause: metatarsalgia (pain in the ball of the patient’s foot), small toe pain, the skin of the patient’s toes rub together and become raw, and, difficulty finding well-fitting shoes. Small toe problems generally occur when the pressures on the toe are much stronger than their joints can resist. This can be due to the following:

The joints are weak: Injury or arthritis may cause the muscles that control the small toes to become unbalanced so that one set pulls harder than the others, thus resulting in the bending of the toe.
Strong pressure: Most often from the shoes that press on the tip of the patient’s small toes as the shoes are tight or it has a high heel that tends to force the toes into the tip of the shoes. Pressure may also be caused from the toe (generally the second toe) being naturally longer than the others.

Problems with the small toes are commonly seen in people with a bunion and they may additionally suffer from bunion pain.

What problems can happen to the small toes?

The 3 main problems that can happen are the pain in the toe joints and metatarsalgia (pain in the ball of the foot), deformity.

Toe deformities occur when the tendons that move the toes get too tight or become out of balance. The toe can rub on other toes and on the inside of the shoe, thus resulting in the pressure and pain. Inflammatory arthritis such as rheumatoid arthritis can damage the patient’s toe joints and this may make them come out of their position.

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What are the benefits of the surgery for the problems of the Small Toes?

The goal of the foot surgery for problems of small toes is to resolve the deformity and, reducing the pain in the small toe joint and in the ball of the foot. Straighter toes should also be able to fit more comfortably in a normal shoe.

What is the alternative of the Surgery?

Putting padding between the toes can help give patients relief from the pain. Using soft shoes from a good-quality shoe shop should be enough. If not, the orthotics department at the hospital will be able to give advice about insoles or special shoes to the patients.

What complications can happen?

General complications

• Pain
• Bleeding
• Infection of the surgical site (wound)
• Unsightly Scarring
• Blood Clots
• Difficulty in passing the urine

Specific complications

• Damage to the nerves
• Damage to the blood vessels
• Problems with the healing of the bone
• Loss of movement in the toes
• Severe pain, stiffness, and loss of the use of the foot (complex regional pain syndrome)
• Pain in the ball of the foot
• The deformity coming back

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Recovering from a surgery carried out for the problems of the small toes

The patients should follow the advice of their healthcare team. The patients may be required to wear special stockings postoperatively. The patients should keep their leg raised most of the time during the first week for reducing the swelling. Thereafter the patients may become more active. Regular exercise should help to the patients for returning them to their daily activities as soon as possible. After a few weeks, if the patients have pins or wires in their toes, the foot surgeon will usually remove them in the clinic. It can take up to six weeks or even longer before the swelling has completely gone down enough for the patients to wear a normal soft shoe. Make sure it is not discomforting and has enough room for the toes. The swelling generally takes up to six months to go down completely. The patients should be able to go home the same day or the day after. The patients should spend most of their time during the first week with their leg raised so that the swelling settles down. It can take up to six weeks or longer before the swelling has gone down enough for the patients to wear a normal soft shoe. Regular exercise should help the patients to return to their day to day activities as soon as possible. Before the patients start exercising, they should ask the healthcare team or their GP for advice.

What does surgery for the small toes involve?

Different anesthetic techniques are possible. The surgery involves putting joints back into their place, releasing or lengthening of the tendons, straightening a toe, and cutting and realigning the bones of the toes. There are a number of different foot operations; the type of foot surgery depends on the lesser toe problem. The patients will be given a local or general anesthetic based on the surgical procedure being done. Surgery is generally carried out using minor procedures. 

The foot surgeon may:

• Release or lengthening of the tendons,
• Returning the joints back to their original position,
• Removing a small piece of bone or tip of the toe,
• Realigning the toe bone,
• Changing the shape of a bone,
• The toes may be fixed in place with the help of removable wires or tiny screws.

Fusion may be needed for more severe deformities when the surgeon removes the cartilage from the end of the toe bones in the middle joint. This is then held with a pin so that the bones can be fused together. If the patients have problems with their small toes that are resulting in the pressure and pain, surgery should be able to straighten the toes and help make the foot fit more comfortably into a normal shoe.

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