Hammertoe, Claw Toe, and Mallet Toe
A hammertoe is a crooked toe that is painful because the first knuckle of the toe sticks up and rubs on the toe box of the shoe. A mallet toe is a toe in which the last joint is bent downward at a right angle so that the tip of the toe is pushed into the sole of the shoe. A claw toe is a toe that is bent at both joints so that it is shaped like a claw. Pain in the ball of the foot is common with hammertoes and claw toes. Each of these deformities occurs because of muscle imbalance of the toe. Muscle imbalance can occur because of age, wearing high fashion shoes, and rarely, certain nerve diseases. The first thing to do for these deformities is to wear roomy shoes with cushioned soles and a deep toe box to reduce the pressure on the prominent knuckle(s). If there is pain in the ball of the foot, a pad can be placed in the shoe to “off load” the painful area. If wearing roomy shoes does not relieve pain, surgery can be considered. Usually a metal pin is placed in the toe to keep it stiff and straight while it is healing. The pin is removed in the office 4-6 weeks post op. Removing the pin causes a minimal amount of pain that goes away in a couple of minutes.
Risks of Surgery:
Occasionally complications or problems such as the following occur during or after surgery.
- Continued pain: It is uncommon to have continued pain.
- Infection: Risk of surgical infection is less than 1%. Antibiotics are given just before surgery to prevent infection. Pin tract infection is a little more common, but is easily treated.
- Bone healing problems: Uncommon, but the risk is increased in smokers and people who are too active after surgery.
- Wound healing problems: Uncommon, but the risk is increased in people with Diabetes, smokers, and people who have poor blood supply to the feet.
- Allergic reaction to medications: Uncommon.
- Blood clot: Rare. In fact, the risk of preventing a blood clot with blood thinners is greater than the risk of getting a blood clot after bunion surgery; therefore, blood thinners are only used in patients who are at high risk for developing a blood clot.
- Anesthetic or Medical problems and Death: Rare, but the risk depends on how many and what kind of medical problems each patient has. Death is extremely rare.
Outpatient Surgery: The surgery is performed in a free-standing out patient surgery center or hospital. Usually patients go home one to two hours after surgery when they are awake, eating, drinking, and using the restroom without difficulty. Typically, pain pills are started before you go home, often before pain is experienced. After surgery, the foot is covered with a bulky, compressive bandage. It is common to see blood on the bandage and it may seem like a lot of blood! But it isn’t. Blood spreads out as it is absorbed by the cotton gauze bandage – much like a drop of water spreads out on a paper towel. Do not worry about blood on the bandage. If the presence of blood bothers you, call the office and we will arrange a time for you to come in for the bandage to be changed.
Anesthesia: “Local MAC,” general, or spinal anesthesia can be used depending on your preference and particular circumstance. Local MAC stands for Local anesthetic and Monitored Anesthesia Care. An IV is started and an anesthesiologist gives you medication that makes you very drowsy, but allows you to breathe on your own. Local anesthetic is used to numb the foot. The local anesthetic usually lasts well beyond the time it takes to perform the surgery; therefore, helps with postoperative pain.
Pain Control: The best way to control pain is to “stay ahead” of the pain. The local anesthesia used during surgery usually controls the pain for 6-8 hours after surgery. This gives you a head start on controlling the pain. You will be given pain pills before going home. For the best pain control, pain pills should be taken every 4 hours for the first 2 days after surgery. At night, set a single dose of pain medication and a glass of water on your bedside table. If you wake up during the night, take the medication. On the 3rd day after surgery, begin taking the pain medication on an “as needed” schedule. Remember, to stay ahead of the pain, medication must be taken before the pain gets out of control. Once the pain gets out of control, it is very difficult to “catch up” with the pain. Don’t worry about using a lot of pain medication the first week after surgery. You won’t become addicted to pain medication by using it for a week or two!
Nausea: Nausea is a common side effect of anesthetic and pain medications. Therefore, nausea medication is prescribed routinely. During the first 2 days after surgery it is recommended that nausea medication be taken regularly. If you have a history of severe post op nausea, please let us know. There are additional measures we can take to minimize this unpleasant side effect.
Walking: In most cases, you will be allowed to walk on the operated foot immediately. Even though you are allowed to walk on the operated foot, it may be uncomfortable, so having a walker or crutches is helpful, so please plan to rent a walker or crutches for the first week or two after surgery.
Swelling: It is common to have swelling after foot surgery and often it lasts much longer than you would like! The best way to control swelling is to elevate the foot above your heart as much as possible during the first two weeks after surgery. It is best to take two weeks off work after surgery so that the foot can be elevated and swelling minimized. Getting back into regular shoes may take several months because of swelling.
Healing: Bone typically takes 6 weeks to heal so you will wear a stiff post op shoe or protective boot for a minimum of 6 weeks after surgery. During this time, avoid excessive or unnecessary walking. If you like to exercise, riding a stationary bike, placing your heel on the pedal is OK.
Driving: Do not drive until you are able to respond in an emergency (i.e. slam on the brakes). This usually occurs after the bone has healed – 6 weeks.
Shoes: Expect to wear begin wearing “foot friendly shoes” 6-8 weeks after surgery when swelling has decreased. Sometimes swelling persists beyond 6-8 weeks. In the summertime, sandals are a good option. In the winter, buy a pair of roomy shoes that fit the swollen foot. If the shoe for the non operated foot is too big, buy an inexpensive cushion insole to put into the shoe. Most of your shoes will fit after the swelling goes down, but it is best to get rid of tight shoes and shoes that have a narrow, pointed toe box.