Hallux Toe Shortening Surgery
Long toes can cause problems with shoes and limitations with activity choices for many patients. The most common long toe presentation is when the great toe (big toe) of the foot, is longer than and uneven in relation to the other toes. When this happens, it’s usually caused by genetic reasons. There are instances where there is a discrepancy with the length of the first toe compared to the other toes because of prior surgery on either the great toe, or the lesser toes. In these cases there is either a complication or an inadvertent length issue.
Ultimately the length discrepancy between the toes causes shoes to fit incorrectly as the sizing and the shoe of the shoe is made for the more average, proportional foot shape.
These kind of problems can also cause a hammertoe like effect on the great toe due to the length. There are tendons on the top of the toe called extensors, and tendons on the bottom called flexors. An imbalance in the function of these tendons can cause the development of a hammertoe, a mallet toe or a claw toe. Long toes can also result in contracture of the joints and develop into hammertoes, claw toes, or mallet toes.
These can in-turn result in painful calluses, Degenerative Joint Disease (DJD, also known as arthritis), and other serious conditions like neuromas or fat pad atrophy.
Conservative solutions can include things like getting bigger shoes. This often solves the problem of contracting and callusing the toes, but it can lead to other conditions because of the lack of support a larger shoe provides.
If you are required to wear what is considered professional attire and you are female, you may suffer with calluses since most women’s shoes are not made with correct foot function or structure in their design.
The Procedure
The evo Toe Shortening correction is a unique approach to surgically correcting a long toe, or potential hammertoe problem. The procedure takes two factors into consideration:
Mechanical and functional correction of a long toe and obtaining alignment of the toes.
Aesthetic approach to surgical correction of this condition.
To achieve these goals, there are two approach to the procedure:
Arthrodesis (fusion) of the Proximal Inter-phalangeal (the joint in the middle of the great toe) is performed with modern method.
Removal of bone in the middle section of the larger bone (proximal phalange) of the great toe to achieve length correction.
A side incision is used so the scar is hidden which can provide better aesthetic results. The joint urbane section will be removed and stabilized during the post operative period with an internally placed implant that will hold the bone sections together while they undergo fusion (arthrodesis). When fusion is achieved, the procedure is complete and the implant is no longer vital to the continued maintenance of the placement of the bones.
If the fusion procedure is performed, the motion at the middle joint of the great toe will be eliminated, but should not limit your ability to walk, run, or bend the toes at the metatarsal joint (unless there is a complication in healing). If the shortening procedure is performed with removal of a section bone, you will have motion at the joint of the great toe.
If you hammertoe condition is caused by tendon contracture, a tendon release or tendon transfer will be performed in an attempt to stabilize the toe and remove the deformity.
Remodeling, shaving of the bone can also be performed in both cases to further improve the deformity. The decision for the kind of procedure will be made by your surgeon based on the presenting problem with your toes.
Possible Complications Related to Hallux Toe Shortening Surgery
Position/Length Variations & Creasing
In rare instances, toes can have tissue contracture which causes over or under correction of the deformity (toe sticks up or down). This can also be true when the bone at the fusion site loses density while healing and results in a toe slightly shorter than expected. Distraction or loosening of the implants can result in a slightly longer toe than originally created. Another unexpected visual result is if the toe exhibits swelling and causes creasing of the extra skin. In this instance revision surgery may be necessary to remove the creases.