What problems can happen to the small toes?

There are 3 main problems that can happen to the small toes.

• Deformity — Change in the shape of a toe.
• Pain in your toe joints.
• Metatarsalgia — Pain in the ball of your foot.

Toe deformities, such as claw toe and hammer toe, happen when the tendons that move your toes get too tight or out of balance. The toe can rub on other toes and on the inside of your shoe, causing pressure and pain.

Inflammatory arthritis such as rheumatoid arthritis can damage your toe joints and this may make them come out of position (dislocate).

What are the benefits of surgery?

Your toes should be straighter, so your foot should fit more comfortably in a normal shoe.

Are there any alternatives to surgery?

Putting padding between your toes and strapping them in place can help give you relief from the pain caused by your toes rubbing.

Using soft shoes from a good-quality shoe shop may be enough. If not, the orthotics (surgical appliances) department at the hospital will be able to give you advice about insoles or special shoes.

What will happen if I decide not to have the operation?

Problems of the small toes do not get better without surgery.

The skin on your toes can become inflamed. The skin can get infected and cause an ulcer. Sometimes this can lead to infection of the bone and the loss of your toe.

What does the operation involve?

Various anaesthetic techniques are possible.

The operation usually takes 15 minutes to an hour.

Your surgeon will discuss with you which of the following procedures the operation is likely to involve.

• releasing or lengthening tendons
• putting joints back into place
• straightening a toe by removing some bone
• stiffening one of your toe joints (arthrodesis)
• cutting and realigning the bones of your toes

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. Nicotine is known to prevent bones from healing.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Difficulty passing urine.
• Blood clot in your leg (deep-vein thrombosis – DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Damage to nerves. This usually gets better but may be permanent.
• Damage to blood vessels, which can cause a toe to die. You will need to have your toe removed (amputated).
• Infection in your toe.
• Problems with bone healing. Sometimes the position of the bone can slip before it heals or healing can take longer than usual.
• Loss of movement in your toes. This often improves with time but there may be some permanent stiffness.
• Severe pain, stiffness and loss of use of your foot (complex regional pain syndrome - CRPS). Your foot can take months or years to improve. Sometimes there is permanent pain and stiffness.
• Pain in the ball of your foot.
• The deformity coming back. You may need more surgery in the future.

Consequences of this procedure

• Pain.
• Unsightly scarring of your skin.

How soon will I recover?

You should be able to go home the same day or the day after.

Spend most of the time during the first week with your leg raised so that the swelling settles.

After that, you can usually start to be a little more active.

It can take 6 weeks or longer before the swelling has gone down enough for you to wear a normal soft shoe.

The healthcare team will tell you when you can return to normal activities. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

The swelling often takes up to 6 months to go down completely.

Summary

If you have problems with your small toes that are causing pressure and pain, surgery should straighten your toes and make your foot fit more comfortably into a normal shoe.

IMPORTANT INFORMATION

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