So your toe is bent to the point where your shoes rub on the top of your to causing pain. The skin is always red and sore. The bending has gotten worse over the past year and at times you have pain in the ball of your foot. What if I told you I could fix the bend in your toe so that the pain goes away? Take it one step further, I can fix the bend in your toe so that the pain goes away, but there will be a pin sticking out the end of your toe for 4-6 weeks. For a lot of people that’s a deal breaker. They want the toe fixed, are willing to deal with the pain and recovery of hammertoe surgery, but don’t want to see that pin sticking out the end of their toe.
This is a big problem and as your surgeon I have to address your concerns. I recognized this early in my training and began using absorbable pins that did not stick out of the toe while I was a resident. Smaller screws became available that could be used in toes and more recently special little devices made of space-age material were introduced just for toe surgery.
I’ve already talked about the difference in hammertoe surgery between the 2nd and 3rd toes as compared to the 4th and 5th. Here I’m talking about the 2nd and 3rd toes only. When I fix the bend in your toe I need to make a stiff, straight toe. I remove the crooked joint and force the bone to heal together straight. That’s why I need to use a pin, screw, or special little device to get the bones to heal together, or in other words fuse. The only question to ask for this part of your surgery is how strong is your bone? That changes my options. Stronger bone means I can use just about anything, but weaker bone limits my options.
Why do some people still have hammertoe surgery with the pin sticking out of the end of the their toe? The most common reason is weak bone. Some things that have been around a long time are still used today because they work in almost every case. Even if your bone is weak a pin can be used to hold it straight until healed. The other reason is the joint at the base of our toe where your foot begins. Many people have toes so badly bent that the joint in the ball of their foot is also bent. More recent advances have shown that breaking the bone in the ball of your foot to straighten this joint is better than the older method of cutting tendons and ligaments. When we used to cut the tendons and ligaments in this area the best way to hold the toe straight was using a long wire. Now we use screws to hold the bone in the ball of your foot without having to use a pin across that joint.
New techniques and new technology are sometimes slow to catch on. Hammertoe surgery without the pin sticking out of your toe is not new. As I said in the beginning, I started doing this when I was in residency. I’ve been training residents for about ten years and even the very first resident I taught learned how to fix a hammertoe without a pin sticking out the end of the toe. When I discuss toe surgery with you I will talk about the options and what I think is best for you. I want to hear your opinion and make sure I’m addressing your goals. It is very important that we are on the same page when it comes to fixing your toe.
Hammertoe toe surgery might be in your future. If you are scared about having a pin sticking out the end of your toe come and talk to me. More often than not I can straighten your toe without having to leave a pin sticking out the end.