ORIF Toe Fractures
Lesser Toe Surgery (PIPJ or DIPJ)
Lesser toes, also called as smaller toes, are those other than the big toe found in your foot. The lesser toe has three phalanx bones, namely distal, middle and proximal and two phalangeal joints, namely distal interphalangeal joint (DIPJ) and proximal interphalangeal joint (PIPJ). The common types of deformities that affect the lesser toes are – claw toe, hammer toe and mallet toe. Lesser toe deformities are caused due to alterations in normal anatomy which create an imbalance between intrinsic and extrinsic muscles. The causes are wearing improper shoes, trauma, inheritance, arthritis, neuromuscular and metabolic diseases. These deformities are accompanied by severe pain and difficulty in walking and finding properly fitting shoes.
Lesser toe surgery or Weil Osteotomy is a commonly used surgical procedure to treat lesser toe deformities. Pressure under the tip of the toe, in the balls of the feet and on the corns on the top of the toes is the cause for pain in patients suffering from deformity. The callous (thick lump of skin) formation and swelling in the joints makes it difficult to walk and wear shoes. Early deformities can be treated by strapping or wearing foot wear which have silicone pads. This provides cushioning to prominent and tender areas of the foot, making you feel comfortable while you walk. If the symptoms still persist after the non-surgical treatments have been tried, surgery should be considered as the best treatment option.
The surgeon will first diagnose the extent of the toe deformity by X-ray. After collecting the details of your medical history and the medications that you are taking, the clinical examinations will be carried out. The surgery is either performed as a day-case (no over-night stay in the hospital) or as an inpatient (with an over-night stay). The surgery is carried out under local anaesthesia combined with sedation or occasionally under general anaesthesia.
The type of surgery depends on the problem being addressed. A small incision (cut) is made across the joint and any bony bump is trimmed thoroughly. The bones may be cut and repositioned in place with the help of surgical screws, wires or staples. Your surgeon may release or lengthen the tendons. Sometimes, an osteotomy (removal of bone) is necessary to fix the problem. At the end of the surgery, the wound is stitched closed and covered with a loose dressing.
After the operation, you are advised to keep the foot above the level of the heart for at least 24 hours to avoid swelling. The soreness and pain will subside with the help of painkillers, but might stay numb initially for 6-12 hours. The wound should be regularly dressed to avoid infection and to facilitate healing. It should be taken care that no pressure is put on the toe while walking for the first 2 weeks. You can resume your regular activities after 2 weeks but it might take 3 months to return to normal. You will be able to drive a vehicle after 6-8 weeks and can return to sports after 3-6 months.
Risks and Complications
As with any surgery, lesser toe surgery involves possible risks and complications. These can include:
- Recurrence of the deformity (occurs in 1 among 10 people)
- Swelling, stiffness and numbness
- Infection and delay in wound healing (might require antibiotics)
- Nerve damage
- Blood clots
In most of the patients, benefits outweigh the risks associated with surgery. This surgical procedure helps to cure the pain and discomfort while walking.