What is it?
Hammer and mallet toes usually accompany bunion deformities but can sometime occur independently. The main problem you will notice is rubbing of the toes on shoes and unsightly position of the toes.
Why does it happen?
Most complex toe deformities accompany bunions and become stiffer and more apparent with time. The can also occur after injuries to the toes or due to muscle imbalance in the foot or tight calves. A large part of my assessment is ruling out any underlying problems which may be contributing to the toe deformities and giving you simple advice on how to stop them getting worse.
How can I treat it?
Toe deformities are usually caused by bunions and underlying muscle imbalance. If the bunion is mild and the deformities are not too severe regular stretching of the toe tendons can help to slow the progression of the deformity. If you have pain from rubbing and want to avoid surgery, there are a number of toe spacers and pads that can relieve pressure on the toes and I will discuss your options with you in detail in the clinic. If you wish to try these splints, I can arrange for you to see a specialist podiatrist who is skilled in making custom spacers and pads to protect your toes.
What does surgery involve?
I do almost exclusively minimally invasive percutaneous techniques for toe deformities. Depending on the severity of the deformity, this can be a simple release of a tight tendon, a controlled break of one of the small bones to realign it or even a minimally invasive straightening of a toe using a small screw. I try to avoid using wires that stick out of the toe whenever possible but if this is necessary I will explain the reasoning to you.
Keyhole toe correction after bunion correction done elsewhere (post op 2 weeks)
Keyhole surgery for severely deformed toes after serious road traffic accident (post op 6 months)
Most toe deformities can be taped using a special form of kenesiotape that helps them to heal in a better position. I will usually apply a corrective bandage and then change this for tape at around 2 weeks. The tape will stay in place for a further 4 weeks after which I will give you exercises to start the toe moving again. On the occasions where a wire has to be used, I will give you clear instructions on how to protect this and I remove the wire in the clinic after 6 weeks. Although this is a scary thought, it is very quick and usually completely painless.
Risks and complications
There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail. Specific risks of this procedure are-
The main problem with toe surgery is residual deformity and recurrence. Minimally invasive techniques utilising the natural tendons and ligaments tend to give a more natural appearance but it is very important to rest the toes in a natural position whilst they heal. This is why I use special tape and if this comes loose, it is important to come and see me so I can reapply it.