Unlike the big toe, the lesser toes have two interphalangeal joints. Claw, hammer, and mallet toes are all caused by tendons in the foot contracting. This makes the toe’s joints curl downwards. Other deformities in this category are curly toe and crossover toe. Hammer toe is the most common lesser toe deformity.
The toes become permanently bent under in a slightly different way in each category, depending on the joints affected. Fluid-filled sacs (‘bursitis’) can develop on the ball of the foot and corns and calluses on the toes. Movement is limited and often painful. If these deformities are flexible, the toes can be straightened out manually. Most lesser toe deformities do require surgery to correct them.
Changing shoes is imperative to allow enough room not to squash the toes, and prevent friction. Specialised products such as splints, toe crests, gel pads and toe shields can also give comfort. If this conservative treatment for accommodating and tolerating the deformity is not effective, surgery can be the answer.
Surgery is usually carried out in a day clinic or with an overnight stay in hospital. Mr. Samarji specialises in treating toe deformities in Manchester makes a small incision which releases and lengthens the tight tendon. A tiny piece of bone is then removed, allowing straightening of the joint. Post-surgery, it is important to keep the foot elevated for a day or two.
It is important that the whole of the foot is examined as there may often be associated problems with lesser toe deformities. Some of the treatment to resolve pain associated with lesser toe deformities may be surgical, but part of the treatment may require adjustment of insoles or provision of insoles as well as carrying out an operation. In the consultation, Richard will explain the nature of the problem to you and the various ways that it can be treated. Following evaluation of your complaint and foot problem, a joint decision between you and Richard would be made about the best way to treat your complaint. It is important that you are aware of the various options open to you in order that you can make the right choice regarding your foot. In order to do this, particularly with regard to considering surgery, it is important to understand what surgery would involve.
The non-surgical options such as adjustments to shoewear and insoles will be discussed alongside the option of surgery. It is important that full consideration is given to all the options that you are able to make an informed choice to how you feel your foot is best treated. The purpose of the consultation with Richard is that you are aware of all the options open to you and that you are able to make an informed choice as to how you wish to have your problem treated.
For lesser toe problems where the toes are flexible, sometimes a soft tissue procedure such as releasing one of the tendons is enough to correct the deformity. When the toe is fixed in an abnormal position, one of the small joints in the toe may need to be fused, in order to straighten the toe and correct the deformity. The toe is held in a corrected position temporarily by using a small bone wire that holds the toe in the corrected position for approximately six weeks until the toe has healed in the corrected position. The wire is then very easily removed in clinic usually at about six weeks following the procedure. Often releases around the base of the toe are needed to correct hammer and claw toe deformities in addition to fusing one of the small joints in the toe. The results of surgery for claw toe, hammer toe, and mallet toe are very good with the vast majority of patients getting a good result. The operations are quick and usually take approximately twenty minutes to perform.
Surgery for lesser toe deformities (claw toe, hammer toe, and mallet toe) are carried out as a day-case procedure. You will need to be starved for a few hours before the operation. After the operation, you can have something to eat and drink following which you will be allowed home. A large amount of local anaesthetic is used making the operation usually a comfortable experience.
Usually, physiotherapy for correction of lesser toe problems is not required.
All surgery carries risks and the risks include infection, bones not knitting, and clots. The risk of complications is very low. The vast majority of patients can expect a good result from surgery. The risks are fully explained in the consultation and a consent form is usually signed at the time of the consultation if a decision to go ahead with surgery is made with all the risks set out.