Mr Jason Hargrave

Apart from the big toe, the so-called lesser toes (2, 3, 4 & 5) are very commonly deformed with a variety of deformity types. These include hammertoe, mallet toes, clawed toes and overriding toes. The 2nd toe (next to the big toe) is most commonly affected, not only by hammertoe but also by being retracted (pulled up) usually as a result of a tight tendon or rupture of the joint capsule under the ball of the foot (plantar plate rupture). It is very commonly seen in association with a bunion deformity.

A variety of surgeries exist to correct these types of problems including shortening of overlong toes. Surgery will include joint pinning and tendon lengthening procedures to achieve good realignment.

Arthroplasty

Used to treat hammertoe and mallet toe deformity as above. The problem toe will be dealt with by removing a small piece of bone from one side of the small toe joint. The repair is then completed by interposing the capsule and tendon into the realigned joint to stabilize the toe. The toe may not be completely straight but will be improved. The toe will remain swollen for around 4months after the operation.

Arthrodesis (often combined with tendon and skin lengthening)

This is used when the toe is retracted at the joint where the toe joins the foot, and when the toe is very unstable. It is also used in the presence of a hallux valgus (buniontype) deformity of the big toe joint, which isn't painful enough to have corrected. The problem toe will be dealt with by removing a thin piece of the joint from each side. The two pieces are then held together with a Kirchner wire (bone pin) in order to set the toe in a straight position. Usually this is combined with lengthening the extensor tendon on top of the toe, which always becomes tighter and contracted when the toe is retracted. The skin may also be very tight and often requires a plastic surgical technique, called a zplasty, to lengthen it so that the toe will remain in its corrected position. Occasionally, the long tendon from under the toe is transferred to the top of the toe, which then reduces the deformity. The toe will be stiff and straighter and by realigning the toe, should reduce pressure at the retracted joint which is often inflamed (capsulitis). The Kirchner wire will protrude from the end of the toe and will remain there for 5weeks; it is then removed in the outpatient clinic. Swelling is common for 46
months following surgery.