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Toe straightening correction

What Is Lesser Toe Contracture?

Here are many variations of lesser toe (toes 2-5) contracture, including hammer toe, claw toe and mallet toe, that can affect all toes except the 1st toe (big toe, hallux). Each problematic position of the toe involves bending into a fixed or flexible condition, often causing the joints or the toe (knuckles) to elevate awkwardly. Sometimes the knuckles can rub against footwear and develop painful pseudo-corns and blisters. There can be a family history of trouble with lesser toes and women are more often affected.1

 

Instability in the large joints at the base of your toes (metatarsal-phalangeal joints) is usually the cause of lesser toe contracture. Often the muscles, tendons and joint surfaces themselves are misaligned causing the position of the toe to change over time. Toes tend to deviate upwards but can also shift from side to side and become problematic for neighbours. A lesser toe contracture can be either flexible (you are able to straight the toe using your hands) or rigid (the toe has a fixed position and cannot be straightened). Rigid positions generally develop after a long period of flexible changes to a toe or secondary to other arthritic developments in the foot. Treatments differ for rigid and flexible positions and expert examination is important in determining how best to treat a particular toe.

 

Lesser toe contracture can occur concurrently with other foot problems, for example it is not unusual for a second toe to contract when a classic 1st tor bunion is present.2 In these cases, hammer toe correction may be undertaken at the same time as another forefoot procedure. Similarly, multiple lesser toe procedures can be undertaken at the same time without substantially impacting recovery time or increasing surgical risk.

Treatment can be conservative with external support or surgical. All procedures aim to reduce pain and increase function of the deviant toe. If there is pain and discomfort associated with an appreciably contracted toe, particularly if you have noticed an increase in the deviation over time your foot should be examined by a Podiatrist or Podiatric Surgeon who are exclusively trained foot and ankle specialists. Dr Pocklington can provide expert assessment and treatment of all lesser toe conditions.

How Is Lesser Toe Contracture Treated?

Lesser toe contracture can be treated conservatively or with surgical correction. It is important to consider conservative treatment before pursuing surgical options, because often conservative treatment can significantly alleviate symptoms.

Dr Pocklington is both a Podiatric Surgeon (foot and ankle specialist surgeon) and trained podiatrist with extensive understanding of the form and function of the foot before and after surgery. This includes consideration of conservative as well as surgical intervention and the overall function (biomechanics of your foot).

 

Conservative treatment for lesser toe contracture involves accommodation and support via taping, strengthening and stretching of intrinsic muscles, shoe modifications, custom orthoses or ortho‑digital devices, and in some cases injection with corticosteroids or other products. Conservative treatment will not reverse the underlying structural changes in your toe, but it can help return the biomechanics of a toe to normal and slow progression of the problematic changes. In some cases of flexible toe positions a minimally invasive or minor procedure in the form of a simple tenotomy (a small cut made through the skin to an appropriate tendon under local anaesthesia) may be useful in reducing or correcting the position of the toe.

 

There are many options available for the treatment of lesser toe contracture and Dr Pocklington can fully assess your feet to determine which treatment is best for you.

When Should I Consider Lesser Toe Surgery?

If conservative measures are not able to alleviate your discomfort or if there is significant pain interfering with normal activities surgical intervention should be considered. Lesser toe contractures can progress over time with positions becoming more rigid. Alternatively, rapid progress of a lesser toe deviation may be secondary to active injury to part of the toe structure, for example the plantar plate of the joint, and can require surgical correction to alleviate symptoms.

 

The goal of surgery is to restore and maximise function in the toe and foot as a whole. The key result is reduction or resolution of pain and a healthy return to normal activities and footwear. As a Podiatric Surgeon, Dr Pocklington is a foot and ankle specialist trained extensively in procedures used to treat problematic lesser toe contracture and can assist you in deciding whether surgery is right for you.

What Does Lesser Toe Surgery Involve?

There are several procedures that can be used to correct a lesser toe contracture. They include:

  • Tenotomy (a surgical cut to a tendon)
  • Arthroplasty (surgical alteration or repair of a joint including with an implant)
  • Arthrodesis (surgical removal of a joint and fusion of the bones)

 

Depending of where your toe deviates, the procedures may be undertaken at the large joint at the base of your toe (metatarsal-phalangeal joint), at one of the two joints in the toe (the interphalangeal joints), or both. With the exception of a tenotomy, which is a soft tissue only procedure, each procedure will involve an incision and surgical fracture (cut) to one or more bones in your foot, allowing the bones to be manipulated and realigned. Depending on the choice of procedure the cuts may be fixated with screws or other fixation devices including surgical plates or wire. Alternatively, an implant may be placed within the joint of your toe to strengthen the corrected position.

 

Each procedure is appropriate for certain presentations and severity of condition. Similarly, each has advantages and risks that Dr Pocklington will discuss with you in detail prior to your surgery. Most procedures take between 20 and 40 minutes to perform. Anaesthetic injections are used to numb your foot locally in all cases, but an anaesthetist will also provide either a general anaesthetic or IV sedation.

Care and Recovery After Surgery

Usually lesser toe surgery is a day procedure allowing you to immediately weight bear on your foot in a stiff sole surgical shoe. Sometimes people stay overnight at a private hospital and return home the following day.

 

Pain relief after surgery generally involves a combination of painkillers and anti-inflammatories, but significant pain relief is often unnecessary. Paracetamol is usually all that is required within the first week.

 

If there has been a surgical cut to the bone, healing usually occurs 6 to 8 weeks after the surgery and during this time restricted activities, including time off work is recommended. For soft tissue only procedures recovery is faster. Dressings are removed and replaced at 1 week, giving you an opportunity to see your progress and discuss it with Dr Pocklington. Sutures are usually removed at 2 weeks. The process of healing after surgery is important and requires ongoing attention from your surgeon. A podiatric range of motion exercise and stretching rehabilitation program begins immediately to ensure function is returned to the foot, toe and your life as soon as possible.

 

Please book online to speak with Dr Pocklington about lesser toe contracture correction.

  1. Hannan MT, Menz HB, Jordan JM, Cupples LA, Cheng CH, Hsu YH. High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis care & research. 2013 Sep;65(9):1515-21.
  2. Meyr AJ, Adams ML, Sheridan MJ, Ahalt RG. Epidemiological aspects of the surgical correction of structural forefoot pathology. The Journal of foot and ankle surgery. 2009 Sep 1;48(5):543-51.

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