THE UK'S FIRST AND MOST EXPERIENCED DEDICATED COSMETIC FOOT SURGERY CENTRE
"I have wanted my big toes shortened for many years but was put off at the thought off the pain I would have to entail however I decided to go ahead after the reassurance Mr H gave me at my first consultation. Mr H answered all my questions & explained fully what the whole procedure would involve as well as the post op care. The operation itself was so relaxed & over so quick & for having both feet operated on at once was certainly the best decision as was advised. Now 3 months on I cannot express how happy I am with the results as are friends & family who have seen them. They look like completely different feet. I am now able to walk without pain & in a lot more comfortable shoes & all this is down to your amazing work. Flip flops are definitely going to be my choice of summer footwear!! Ms C S, Cambridge."
This is one of the most commonly undertaken procedure in our practice and was pioneered in the UK by our specialist Consultant Podiatrist Mr Hargrave. These patients usually suffer with toes which are over long and complain they cause rubbing in shoes and have real difficulty finding shoes to fit comfortably as well as the aesthetic appearance. Commonly it is the 2nd and 3rd toes which are longer than the big toe and this affects men as well as women.
As well as causing some people embarrassment because they dislike the way their feet look, longer toes also commonly cause discomfort. As a consequence of not being able to find shoes which fit properly the toes compensate by clawing to keep the shoes in place. This can then cause painful corns and lumps underneath the skin called bursitis, which form over the small knuckles of the toes.
Pros and Cons of external pins versus the Nextra internal toe clip:
All toe fusion procedures carry a risk of failure to unite (non-union). This risk is around 5% and is the main reason why a toe may need to be re-operated on (revision surgery). Using 2 external Kirschner pins is a long-established and recognized way to fuse the toe joint. The pins exit the end of the toe and are removed in outpatients at 5-6 weeks after surgery. Signs of full bone healing can take up to 3-months to show on x-rays.
More recent innovations involve the insertion of a small metal clip which stays inside the toe bones and which only requires removal if the fusion fails to unite (e.g. Nextra implant).
Although these implants have not been used as long as pinning and therefore have less evidence behind their use, we believe they carry many advantages over the old-fashioned pinning technique.
Pins carry a higher risk of infection than clips since they exit the toe end and therefore bacteria can track along the pins causing a pin-tract infection (approx~ 2% risk). Implants anecdotally cause less post-op swelling and allow much earlier return to bathing and closed shoes, driving and work (often at only 2 weeks post-surgery). Patients with pins are strongly advised to wear a walker-boot until the pins are removed (which is an additional cost). Because there is less risk of the bone ends twisting or distracting (moving apart), the Nextra clip is more stable than pins, and we believe it reduces the rate of non-union and failure of the surgery.
The procedure takes about 10-15 minutes per toe to remove a portion of one of the toe's small joints and insert our Nextra clip.
Both feet can be undertaken together. The major healing period can extend for many months afterwards but the results should be lasting.
The procedure can be performed under a local anaesthetic as an outpatient procedure (hospital or surgical facility.); or as an inpatient under General Anaesthesia (GA)
The most critical part of the procedure is determining the appropriate amount and location of bone shortening. Even a few millimetres of shortening can make a significant visual difference. The shortening is performed at either of the two joints within the toe using a specialized bone cutting instrument. Depending upon the amount of bone shortening, a portion of the skin then needs to be remodelled or removed. After the internal shortening has been completed, 3 small stiches are used to closed the small wound, which are removed after 2-weeks. The new toe length and alignment is immediately evaluated.
After the surgery walking carefully but only on the heels with crutches is allowed for the first week. A surgical shoe is provided for this period. 7-14 days after the surgery, the patient is seen for a dressing change and at 2-weeks the stitches are removed. During the first two weeks, in order to minimize swelling, ice packs should be applied and the feet should be elevated as much as possible. After the bulky dressing is removed, the foot can be placed in a roomy shoe such as a trainer, Ugg boots or strappy sandal; and full weight-bearing is allowed.
Pain medication is provided for a few days post-surgery. Swelling may will persist up to 6-months after surgery and you will have to modify your footwear to accommodate this initially. Driving is permitted after 2-weeks as is working if you have a desk-type job. We advise the use of various scar-care products, which can be discussed after surgery.
The results are usually permanent and functionally and cosmetically pleasing; but it should be noted that the toe will be stiffer and the middle joint won’t flex afterwards. Functionally, this does not impair your ability to exercise or play sports.
We are offering free consultations from now through to the end of April.