Have you a toe that won’t sit down?

I know we’ve shown you several of these over the last few years, but it’s such a satisfying procedure to perform and the almost instant relief patients experience never gets old.

These little toes don’t decide to curl or contract just for the fun of it. This happens because the foot structure is unstable and in a desperate attempt to combat that, the muscles strain to regain control. Some of these postural muscles that stabilize the foot also have secondary roles as flexors or extensors on the toes. When they struggle for a long time and muscles shorten producing deformities in the toes like clawed toes, hammer toes, and mallet toes to name a few.

If caught early enough these misalignments remain flexible and correctable. If left too long the joints will inevitably develop osteoarthritis. the associated loss of range of movement prevents us to being able to correct with a simple release of the offending tendon.

Typically with cases like this, we will perform a full exam and Pedigait video analysis to discover the underlying structural cause. Our patients will attest to the fact that, before choosing to have this procedure they watched their feet in slow motion demonstrating exactly how the deformities develop.

 Once we have addressed the functional instability we urge our patients to wait and see if the tendons will naturally reverse the prior contracture. Frequently this is exactly what happens and not only does it show that the functional control has been successful but it avoids the necessity for surgical intervention.

In those cases where we have stubborn little piggies then its time to be a little more persuasive!. 

One major advantage of this procedure is the minimal downtime recommended. Usually, we ask the patient to take it easy and non weight-baring as much as practical the evening following the surgery. Next day they return to normal walking and avoid high impact or significant strain until the suture(s) is removed seven days later. Walking is encouraged as the gentle force will assist in the stretching and correction of the soft tissue contractures in the surrounding tissues.

Typically the painful corns, callouses or diabetic ulcers associated with the digital deformity will heal and often completely resolve if the pressure reduction is adequate.

My mantra during 10 years teaching surgery to students at Toronto General Hospital and subsequente postgraduate surgical courses has been, “the most important criteria in elective surgery is the suitability of the procedure to the patient’s unique condition”. Never does one solution fit all. Frequently we get patient referrals from colleagues for this type of surgical intervention, and frequently we are forced to disappoint someone as being unsuitable. Proper evaluation is every bit as important as good surgical technique.