What does the operation involve?
The operations for lesser toe deformities depend upon the age of presentation and type of deformity. In children the operative procedures include:
- Flexor tenotomy: A small cut is made on the under surface of the toe and the tendon incised such that the toe can straighten. This is an operation with a quick recovery, between ten to fifteen days.
- Tendon transfer. Flexible deformities can be helped by transferring the tendon from the bottom to the top of the toe.
- Joint fusion. Fixed deformities which cannot be corrected by straightening the toe require a bony procedure such as joint fusion or arthroplasty.
In adults the general operations chosen are:
- Tendon transfer
- Exploration and release of the metatarsophalangeal joint
- Joint fusion
- Osteotomy to the metatarsals and combined procedures to the toe. This is more extensive surgery, and involves cutting the metatarsal bone and fixing it with a screw.
Each procedure chosen for a patient is unique and the surgeon will discuss it with you. Simple procedures can be performed as a day-case under local anaesthesia, whereas others require general anaesthesia and an overnight stay.
What about pain?
You may be given a local anaesthetic nerve block to ensure immediate post-operative pain relief. Whilst you are in hospital you will be monitored and the medical staff will give you painkillers as required and prescribed. When you are at home you may find Paracetamol and/or anti-inflammatories useful for controlling any pain. Instructions on the management of pain will be given by the nursing staff before you leave the hospital.
How long does recovery take?
Most patients who have lesser toe surgery alone will go home the same day. The majority of patients have only a padded dressing and bandage to the wound but there may be a wire protruding from the end of the toe, to hold the toe straight during the recovery phase.
You may be given a special shoe, which helps to off load the forefoot. The physiotherapist will give instructions on how to wear the shoe as well as the use of elbow crutches.
For the first two weeks you are advised to restrict your walking distance to within the house and garden and to elevate the foot as much as possible.
Your wound dressing will be changed at 7-14 days and the stitches removed or trimmed. You are advised to keep the dressing clean and dry until the stitches are removed. If you have a wire in the toe, you will be seen again at 4 weeks, and the wire removed. Once the bandages (and wire) are removed it is advisable to wear loose fitting shoes (e.g. ECCO, Hotter or sports shoes). Normal footwear (which is well fitting) can be worn about three months after the operation.
People vary in how quickly the swelling disappears after surgery and three months is not at all unusual. Provided you are not having undue pain or inflammation there is probably nothing to worry about and you can afford to give it time.
Patients having had only the left foot operated on will be able to drive an automatic car within two weeks. Those who have had an operation on the right side will be able to drive after about 4-6 weeks, depending on the operation. You are advised not to fly after surgery for about 6 weeks. Swimming will be possible once the sutures (and wire) are removed and the wound is healing satisfactorily.
When can I go back to work?
This will depend on the type of work you do. For example if you have a desk job and can do your work with your foot up and in a special shoe you may be able to return to work after 2-4 weeks. If on the other hand you do manual work where there would be a lot of pressure on the foot then you may need 8-10 weeks off work.
Can anything go wrong?
All operative interventions have an inbuilt risk and complication rate. The risks following Cheilectomy / Moberg osteotomy are as follows:
Infection in the wound or wire
Prolonged swelling
Nerve injury
Recurrence of deformity
The above complications are rare but can occur.
