Lesser Toe Deformities

Presentation

• Lesser toes (2-5) can have various problems including hammer, claw, mallet and cross over deformities. These changes may be associated with bunions or big toe arthritis.
• Patients often have troublesome callocities or ulcers on their toes due to pressure from footwear.
• Patients may also have pain under the ball of their foot, due to overload whilst their walking - this could be due to long metatarsals or other foot deformity.

Investigation

Your GP should initially request these investigations:

• Weight bearing foot X-ray (AP, oblique and lateral)

Your surgeon may also request the following investigations for more information or surgical planning:

• No other investigations are usually required

Conservative Treatment

Initial treatment of Lesser Toe Deformities could include:

• Accommodative footwear with padding over prominent areas.
• Orthotics such as a metatarsal dome may relieve discomfort.
• Injection of steroid and local anaesthetic into MTP joint can provide diagnostic information and therapeutic relief.

Surgical Treatment

Surgical treatment of Lesser Toe Deformities includes:

Weil’s osteotomy - shortening and elevating metatarsal

• Incision over top of foot
• Metatarsal cut at an angle with saw and shortened
• Held with a screw
• Wound closed with non-absorbable stitches
• Foot bandaged and placed in Darco MedSurg flat shoe Toe correction - with proximal and/or distal interphalangeal joint fusion
• Eliptical incision over bent joint
• Joint surfaces removed with saw
• Screw passed from end of toe across joint to compress it.
• Sometimes a wire is passed along toe to hold it straight for 6 weeks
• Wound closed with non-absorbable stitches
• Foot bandaged and placed in Darco MedSurg flat shoe

Condition specific risks include:

1. Malunion
2. Non-union
3. Metalwork failure
4. Recurrence of deformity

General risks of surgery include:

1. Infection
2. Damage to nerves/blood vessels
3. DVT / PE (blood clots)
4. Anaesthetic risks

Recovery

Recovery from Lesser Toe Deformities surgery will include:

• Keep foot elevated as much as possible, especially for initial 72 hours
• Keep dressings dry and intact until post operative appointment.
• Pain killers may be required for up to 2 weeks.
• Removal of stitches: 10-14 days at first post operative appointment.
• Weight bearing as tolerated in flat Darco shoe for 6 weeks
• Removal of wires in clinic if required
• Recommencement of most activities: 12 weeks. Full recovery: 3-6 months.

Every patient’s recovery is individual and depends on the severity of the injury and the complexity of the surgery.