Outpatient or hospital stay: Almost always outpatient (home same day)
Type of anaesthesia: May be regional or general, or a combination
Length of surgery: Depends on the number of toes to be corrected
Recovery time: 6 weeks (to pin removal) for normal walking, up to 6 months for vigorous activity
If wearing proper shoes and orthotics does not alleviate your pain then surgery may be required. The goal of surgery is to correct the deformity. There are many ways to correct a claw toe. How much surgery is required is often determined by the extent and rigidity of the deformity. The more crooked and stiff the toe, the more surgery is required.
The surgeon starts by releasing the tight tendons and ligaments. If the toe can be straightened after the soft tissue release then no further surgery is required. If, however, the toe remains crooked after the soft tissue release then the surgeon will cut the bone to properly realign the toe. After the toe is straight the surgeon will often use a pin to hold the bones and joints in place. The pin often can be seen at the end of the toe.
- You may have a bandage or dressing to protect the incision for about 1 week.
- You will be instructed on caring for your dressings, and if and how much weight you can bear on the foot.
- You may wear a special post-operative shoe with a stiff sole that protects the toes by keeping the foot from bending, or removeable cast.
- Avoid bending the toes – excessive movement can break the pins.
- Keep your dressings dry (place a plastic bag on your foot when showering).
- Watch for complications. Alert your surgeon or visit an emergency room if you experience bleeding that won’t stop, pain that does not subside with prescribed medication, swelling that worsens (or dressings that become too tight – remove them, but visit an emergency room immediately following) after the second day, drainage from the wound, and/or have a fever higher than 38°C or 101°F.
The stitches are generally removed in 10 to14 days. The pins are usually removed after the bone begins to mend, typically in about 4 to 6 weeks. It is common to still have swelling 4 to 6 months post-surgery, but it will eventually resolve.
- Infection around the wire penetration site. If a wire is used to maintain the position, keeping the tip of the toe clean is very important until the pin is removed. This normally needs to stay clean, dry, and protected from possible trauma.
- Swelling of the toe. The toe can remain swollen for many months. It is not uncommon for swelling to last upwards of 6-12 months after surgery.
- Malposition. It is not uncommon for the joint to be fused in a slightly off-centered position, which in some instances can be problematic.
- Blood vessel vascular injury. There are two small blood vessels that run on either side of the toe. If these are injured, the blood flow to the tip of the toe may be lost. This can result in necrosis of the tip of the toe. Although rare, this may lead to a second surgery and partial amputation of the toe.
- Residual pain: As the toe is a relatively confined space, it’s not uncommon to have swelling and residual pain for an extended period of time.
- Toe Shortening: By removing a small piece of bone prior to fusion, the toe will be slightly shortened.
PIN SITE CARE IS IMPORTANT
Avoid soaking your foot in water such as a bathtub, swimming pool or hot tub which can cause infection. (If the infection does not resolve with appropriate antibiotics, then the pin may have to be removed.) Your surgeon will instruct you on routine care of the exposed pin sites which may vary from daily cleansing or leaving the post-surgery dressing untouched. If the toe becomes red, hot, swollen, and/or starts draining fluid, see the surgeon or go to the nearest emergency department for assessment.