Claw and Hammer Toes are similar deformities that can cause the toes to rub on the shoes or each other. Surgery can be used to straighten the toes, either in isolation or as a component of more extensive surgery. It is commonly included with correction of bunions or hallux valgus.
Surgery should be considered for toes that rub and have failed non-operative treatment.
Sometimes it is used in conjunction with other operations for pain in the ball of the foot (metatarsalgia).
You will be given a full briefing of how to prepare for your procedure well in advance of the day of surgery. In very general terms you will need to...
- Let our team know what other medication you are taking and follow our guidelines on taking these medications in the days/weeks before surgery.
- This is particularly pertinent to blood thinning medications such as aspirin, warfarin, clopidogrel and Xarelto.
- Let our team know if you develop symptoms of any illness (including a cold or fever) or if you believe you may be pregnant.
- If you smoke, stop smoking ideally several days or weeks ahead of the procedure, but at the very least not smoke after midnight the night before surgery.
- Maintain your strength and mobility as best as possible.
- Not eat or drink anything for a minimum of 8 hours prior to admission.
- Bring all available and relevant imaging with you to hospital.
The operation is usually undertaken as a day case procedure. You will be admitted and go home the same day. General anaesthesia is supplemented with local anaesthetic or a nerve block. An incision is made on the top of the toe and the opposing surfaces of the joint are excised. The bones are aligned straight and fixed in place using a special pin, made of the same material as dissolving stitches. If the joint where the toe joins the foot is also contracted, the tendons, joints capsule or ligaments here may be lengthened to bring the now straight toe, down, so that it lines up with the foot and other toes. This results in a toe that is stiff in the middle, but still moves on the foot. The stiffness in this joint does not affect walking.
The incisions are closed with regular stitches and bandage dressings are applied.
This video animation shows the fixation of the joint with the pin.
Immediately after surgery, the foot must be kept elevated (above the level of the heart) to reduce swelling. This is especially important over the first 2 weeks. Patients also receive pain medication if required.
You may walk on the foot. A post-op shoe will be provided to wear over the bandages when walking. The bandages are to be left in position until your review appointment. This will mean having to use plastic bags and tape to protect the dressings when showering.
At 10-14 days you will be seen and the wounds checked, sutures and dressings are removed. You may wear regular shoes after this time. Although it is possible to start returning to activity after this point, it is important to remember that the toe will still swell and ache for a few more weeks if you do too much.
Most patients are well recovered and back to full activity after 8-10 weeks.
All surgery carries with it some form of risk. Common risks that apply to all surgery, including claw toe correction, are...
- Formation of a blood clot (“DVT” or deep vein thrombosis) Pieces of clot in the leg can break off and lodge in the lungs causing a pulmonary embolism. This can be very serious, and in rare cases even cause death.
- Nerve damage.
- Difficulty getting the wound to heal.
- Abnormal pain reactions or nerve hypersensitisation known as complex regional pain syndrome (CRPS).
Risks specifically related to this procedure include...
- Incomplete correction of the deformity. (It is difficult to correct any sideways deformity with this procedure and the toe may still sit up a little).
- Loss of fixation of the joint causing pain and early recurrence of deformity.
- Persistent pain or rubbing.
- The swelling of the toe can sometimes take longer than expected to resolve.