What does the operation involve?

The operations for lesser toe deformities depend upon the age of presentation and type of deformity. In children the operative procedures include:

  • Flexor tenotomy: A small cut is made on the under surface of the toe and the tendon incised such that the toe can straighten. This is an operation with a quick recovery, between ten to fifteen days.
  • Tendon transfer: Flexible deformities can be helped by transferring the tendon from the bottom to the top of the toe.
  • Joint fusion: Fixed deformities which cannot be corrected by straightening the toe require a bony procedure such as joint fusion or arthroplasty.

In adults the general operations chosen are:

  • Tendon transfer: Exploration and release of the metatarsophalangeal joint
  • Joint fusion: Fixed deformities which cannot be corrected by straightening the toe require a bony procedure such as joint fusion or arthroplasty.
  • Osteotomy to the metatarsals and combined procedures to the toe: This is a more extensive surgery and involves cutting the metatarsal bone and fixing it with a screw.

Each procedure chosen for a patient is unique and the surgeon will discuss it with you. Simple procedures can be performed as a day-case under local anaesthesia, whereas others require general anaesthesia and an overnight stay.

What about pain?

You may be given a local anaesthetic nerve block to ensure immediate post-operative pain relief. Whilst you are in hospital you will be monitored and the medical staff will give you painkillers as required and prescribed. When you are at home you may find Paracetamol and/or anti-inflammatories useful for controlling any pain. Instructions on the management of pain will be given by the nursing staff before you leave the hospital.

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How long does recovery take?

Most patients who have lesser toe surgery alone will go home on the same day. The majority of patients have only a padded dressing and bandage to the wound but there may be a wire protruding from the end of the toe to hold the toe straight during the recovery phase.

You may be given a special shoe, which helps to off load the forefoot. The physiotherapist will give instructions on how to wear the shoe as well as the use of elbow crutches.

For the first two weeks you are advised to restrict your walking distance to within the house and garden and to elevate the foot as much as possible.

What are the possible complications?

  • Infection in the wound or wire
  • Prolonged swelling (this can last 3 to 6 months)
  • Nerve injury
  • Recurrence of deformity

The above complications are rare but can occur.