Toe Shortening and Straightening

Hammer toe is a common deformity that causes toes to bend downward instead of pointing forward. This can cause significant pain and difficulty in wearing shoes comfortably. Hammer toes will progress over time until the toes become dislocated. It can occur in any toe, but most often appears in the second or third toes. Although a hammer toe may be present at birth, it most often develops over time. If you are unable to flex your toes, then hammer toe surgery is the only option to restore movement.

Toe reduction surgery helps to eradicate common toe deformities, such as an over-long second toe known as Morton’s Toe which may result in hammer toes developing. There are two different methods of toe reduction. These are joint resection (arthroplasty) or bone mending (fusion). The technique used depends on exactly where the toe is too long or is employed at the site of any buckling of the toes.

During toe shortening surgery, the surgeon will carry out a digital arthroplasty, involving removing some or all the small bone that forms the joint within the toe. Once the toe or toes are shortened to the desired length, a small pin or wire may be inserted to hold the newly shortened toe in place to help the toe retain its flexibility. An over-long second toe nearly always requires this medical hardware to aid healing and to keep the toe fixed in its new position whereas the fifth toe rarely requires any wire or pinning.

Toe straightening surgery can be carried out on one or several toes during a single procedure. This surgery restores a natural appearance to your feet by correcting misaligned toes that may be bent or out of proportion to the others. Misaligned toes are often related to the presence of bunions, a prominent bump at the base of the big toe. Toe straightening surgery is for people who have crooked or angular toes, which may be caused by a bunion.

The surgeon will begin by making an incision along the top of the affected toes. The joint at the base of the toe is loosened and the surgeon may decide to remove some of this bone from the joint to allow for a full correction. Bone is removed from the middle joint of the toe to reshape and straighten the toes. The surgeon may also reroute a tendon from the underside of the toe to the top of the toe to enhance the result. A pin is inserted into the toe tip to stabilise the now straightened toe and maintain the result.

You will have up to two 60-minute consultations with your specialist podiatry surgeon at our Chelsea based clinic to discuss your concerns around your toes and the results you are looking for. Your surgeon will take the time to explain the best procedure for you and how this would be carried out, as well as giving you an indication of the results you can expect by sharing previous before and after photos with you.

To get the most from your consultation, we recommend writing down any questions you have for your surgeon in preparation. This ensures you don’t forget anything that is important to you and your surgeon can steer the conversation in the right direction for you.

During your consultation your surgeon will also conduct a full health and wellness assessment, take measurements of your toes and feet and capture photographs for your medical record.

Once your surgeon has prepared your surgical plan, they will send it through to your patient advisor. Your patient advisor will contact you to discuss the procedure your surgeon has suggested as well as the price and available surgery dates that may suit you. You will then have a two-week cooling off period to consider your options and decide whether you wish to undertake the toe shortening and straightening surgery.

 In the weeks running up to your surgery, you will be asked to prepare using the following steps:

• You will be asked to complete your pre-operative paperwork for your surgical team to review and approve you for surgery.
• Your surgeon will ask you to stop smoking and/or vaping for six weeks before your surgery can take place. This ensures you heal fully and properly in a shorter time frame.
• You will also be asked to cut down on drinking alcohol as excessive alcohol consumption can also impact the healing and recovery process. In the final 48 hours before surgery, you shouldn’t consume any alcohol.
• Don’t take anti-inflammatory medications such as ibuprofen and aspirin, or any herbal supplements as these can increase the risk of bleeding in the week before your surgery.
• Please organise for a family member or friend who can either drive you or accompany you in a taxi and stay with you for the first night to collect you after your procedure.
• You mustn’t eat any solid food or consume any juice or milk (including tea or coffee) in the 6 hours before you arrive at the clinic. You can have sips of clear liquids (water, or black tea and coffee) up to 2 hours before you arrive at the clinic.

Your arrival time at the clinic will be an hour before your surgery is due to begin. You will be taken into our pre-operative assessment area, where a nurse will check your vital health signs and ask you to dress in a surgical gown with compression stockings. Your surgeon and anaesthetist will then answer any final questions you have, and your surgeon will make any markings they need to carry out your procedure.

You will then be taken into theatre. If your procedure is being carried out under general anaesthetic so you are completely asleep, this will be administered by your anaesthetist. All general anaesthetic procedures at Cadogan Clinic are performed with TIVA (Total Intravenous Anaesthesia) which reduces nausea while you are recovering and allows you to wake up faster. If your procedure is being undertaken with local anaesthetic, your surgeon will administer this.

Your surgeon will then carry out the procedure. Once your procedure is complete, you will be taken first to our recovery ward and then to our ambulatory ward. In our recovery ward, the nurses will monitor your vital signs and let you wake up from the anaesthetic. In our ambulatory ward, you will have your own room, where you will be given some food and drink and can spend a few hours relaxing. When you are ready, the nurses will prepare you to be discharged by explaining any medication and aftercare you need and calling your chaperone.

Following toe shortening and straightening, you will be asked to minimise any movement for up to two weeks. This helps your toes to heal effectively and maintain the shape the surgeon has created.

One week after your surgery you will have a check-up with our nurses to monitor your healing and provide any advice you need about your dressings. You will then return, two weeks after your procedure, so your stitches and any temporary pins or plates can be removed. However, for your second toe fusion surgery recovery time, you may need further appointments every 3-4 weeks so we can continue to check if the toe has fused yet. If it hasn't, you will be asked to wear a splint and you will be invited back to the clinic for further follow-ups.

All being well, six weeks after surgery, you have an appointment with your surgeon where they will assess your recovery and discuss your results. They will be able to answer any questions about what you should expect going forward before signing you off. If you have any questions beyond this point, you will still be able to speak with our nurses, and if necessary, book further follow ups with your surgeon.