It’s always lovely to reconnect with a patient after several years. 

In this particular case these feet have covered many miles in archaeological digs from Egypt to China. Several years ago we helped address a structural instability in their feet by changing footwear buying/wearing habits, and introducing custom functional orthotics. We then performed a minor surgical procedure to straighten his right 4th toe that had become contracted over the years causing pain in both 4th and 5th toes.

Fast forward, now the left 4th toe is becoming bothersome with extended activity. The orthotics are still working well, time for some new footwear, and yes time to perform the same correction to the Left 4th.

The same one muscle controls contraction of all small toes (flexor digitorum longus), with an increased angular pull towards those on  the outside of the foot. The result of this is, this is that over time the 2nd and 3rd toes continue to have a straight pull / curl, but progressively the 4th and 5th toes curl and rotate slightly.  Thus causing them to impinge on their neighbouring toe causing painful corns and calluses.

The contractures generally become worse over time and eventually the joints in the toes loose their flexibility necessitating a more complicated boney procedure to correct the issue. This type of correction would also require more consideration and limit mobility postoperatively. Generally when assessing suitability and the type of procedure to be performed we use our PEDIGAIT ( digital video gait analysis) to see exactly how the toes are functioning during the gait cycle. This has time and again, proven to be an invaluable resource in confirming suitability and demonstrating to patients the rational behind them choosing a surgical solution.

This is not the only solution to this condition but we believe our patients need all the information they can get in order to choose the appropriate path for them. Not having all the options presented and rationalized, is no option at all.