Common Types of Toe Surgeries

Introduction

The foot and ankle encompass a complex set of joints, tendons, and ligaments that are a masterpiece of engineering in that they allow ambulation and shock absorption and function with smooth transition of forces and balance to the body. Broadly speaking, the foot can be divided into the forefoot, hindfoot, midfoot and the ankle as a separate entity. This blog will outline the 5 common types of toe surgeries that are performed at the London Foot and Ankle Surgery by our consultant podiatric surgeon, Kaser Nazir.

Toe surgeries can address an array of deformities that cause pain and restriction in the types of footwear. They are progressive in nature and can initially start as mild deformities and lead to dislocation of toes and chronic osteoarthritis changes.

1. Bunion Foot Surgery

   Bunion surgery involves resetting the bones of the big toe and the first metatarsal to realign the bones, thus reducing the prominence of the metatarsal head, which is where most patients identify pain. Bunions can progress very quickly, although in many patients, they are of genetic cause and can start in early teens.

   The osteotomy procedure is now performed under local anaesthetic and sedation with keyhole techniques. Specialised screws made out of titanium are used to fix the bones in a new position, allowing early mobilisation. The typical recovery will still take 6 to 8 weeks, but you are mobile throughout that recovery, although the first couple of weeks require quite a bit of rest.

   The risks of infection, joint stiffness, and long-term disability are reduced with the minimally invasive surgery techniques. The foot surgeon will use specialised instruments for cutting bones such as specialised burs and specifically designed instrumentation to move the bones into corrected position, thus allowing excellent correction and long-term results.

2. Hammertoe Foot Surgery

   Hammertoes are generally caused by an imbalance of tendons and ligament structures, which over time result in claw toes or hammertoes. The joints in the middle, known as the interphalangeal joints, become stiff and gradually progress from a flexible state to a very rigid state. When rigid, they cause ulceration and corns. The toes rub against shoes and cause pain. Footwear fitting becomes difficult for patients, who often present with pain in the bone of the foot.

   The foot surgery involves removing the joints and resetting them by either fusing them or removing part of the joint known as arthroplasty procedure. The procedure can be performed under local anaesthetic with or without sedation as a day case. You will use a postoperative sandal for 2 weeks. The deformities are corrected long-term to prevent recurrence. Sometimes tendon and ligament releases or lengthening will also be performed alongside bony procedures.

   Screws and wires can be used to ensure that the bones are held in the correct position during the healing stages. With recent techniques, these can be performed with minimally invasive and keyhole procedures. Little screws are used internally rather than K-wires placed outside the joints to help align the toes and hold them in position.

3. Arthritic Big Toe Surgery

   Arthritic big toe is also known as hallux rigidus. Sometimes patients present with a spur of bone, but essentially, there is significant cartilage damage and bone-on-bone contact, which causes pain and gradual stiffness of the big toe joints.

   The procedures either involve cleaning the joint or replacing the joint with an implant. Sometimes the big toe surgery involves fusion of the big toe, which is the gold standard for long-term stability. Your foot surgeon would discuss the correct treatment for you, but all operations are performed as day cases. The best operation depends very much on the activity levels expected by the patient and their age. Robust procedures are required for younger patients to ensure that they can maintain an active lifestyle in terms of running and jumping.

4. Turf Toe Surgery

   Turf toe results from injury or insult, particularly when you stub the big toe. This is common in football. The tendons and ligament structures on the ball of the first toe become torn or lengthened. This results in the claw toe formation. Early repair of those tendons can restore full function. However, should it not be repaired early, then you may require more aggressive surgery in terms of fusion of the joints and tendon lengthening procedures.

FAQs

How do I know if I need foot surgery?

Foot surgery indications very much depend on your symptoms. If you’ve got pain on a regular basis or footwear difficulty, then one would consider foot surgery to correct this in the long term. Early diagnosis and treatment can sometimes be helpful to prevent joint damage and destructive surgeries in the future.

What is hammertoe and how is it treated surgically?

Hammertoe is a fixed flexion deformity of the interphalangeal joint. The surgery involves removing the joint and placing a screw to allow the bone to heal in a straight position.

What is foot surgery, and when is it necessary?

Foot surgery techniques involve any surgical procedure that affects the 26 bones of the foot and all the ligaments and tendons. It is necessary when conservative treatment has failed and simple treatments like insoles or strapping have failed to resolve pain.