We are finding an increased number of patients coming to us requesting toe shortening. These patients usually suffer with toes which are over long and complain they cause rubbing and have real difficulty finding shoes to fit. Commonly it is the 2nd and 3rd toes which are longer than the big toe and effects 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 compensete by clawing to keep the shoes in place. This can then cause painful lumps and bumps as well as constant rubbing at the heel.
The procedure takes about 15 minutes per toe to remove a portion of one of the toe's small joints and insert bone pins or screws. After 5-6 weeks patients can have the pins removed, although screws remain in-situ, both feet can be undertaken together. The major healing period for this procedure is about three to six months and the results should be lasting.
The procedure can be performed under sedation with local anaesthesia 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 millimeters 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, a plastic sutured skin closure is performed. The new toe length and alignment is immediately evaluated.
Recovery following surgery
After the surgery the patient is able to walk carefully with full weight-bearing on both feet, with crutches for the first week. A special surgical shoe is provided. Approximately seven days after the surgery, the patient is seen for a dressing change. At two weeks post surgery, the patient is seen to remove the sutures. Suture removal is minimally uncomfortable.
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.
A moderate and gradually increasing amount of walking is allowing after a few days following surgery. Pain medication is required for a few days post-surgery. A sandal or roomy trainer type shoes can be worn two weeks after the surgery. If pins are used they are removed in the outpatient clinic at 5-6 weeks, without the need for anaesthetic. Swelling will persist for several months after surgery and you will have to modify your footwear to accommodate this initially. Driving is permitted after pin removal. 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 there will be a small loss of toe flexibility, however this will not affect your ability to exercise or play sports.