Short Toe & Failed Hammertoe (Toe Reconstruction Surgery)

Hammertoe surgery is a common procedure that is performed in podiatric surgery.  These procedures often involve cutting or removing bone.  One of the possible complications is contracture or collapse of the pseud-arthrosis (the fibrous cartilage that fills the gap left by the removal of bone) which can occur after this procedure.

When this happens, the toe will contract as well and become shorter than expected.  This can cause pain, difficulty with balance and difficulty with shoes.

The Procedure

The evo toe reconstruction procedure is a unique approach to surgically correcting a failed hammertoe surgery or genetically deformed, short toes.

Toe lengthening involves three steps.  The first is meticulous dissection to separate the fibrous scar tissue from viable normal tissue.  This is done with an incision on the side of the toe, between the neuro-vascular bundle (nerves and arteries). Some toes will require the incision to be placed on the top because of poor results from the previous surgery.  Once the tissues are separated, the toe will extend to the normal position.  At this time the fibrous pseud-arthrosis is cut out to make room for the implant.

The joint implant can be composed of custom shaped Silastic (silicone and plastic mixture), Titanium, or Bone Graft.  The implant is placed in the space.  At this time the tendon needs to be repaired so the toe still retains some of its functionality, if possible.  This is done by one of two methods.  The first is a tendon lengthening.  If there is not enough tendon to lengthen however, a tendon transfer may be performed.

It is important to note: Toe Reconstruction is an attempt to correct a previous complication that is often considered a final result.  If there is failure of the procedure, due to the unique methods used in this surgery, we request that you provide us the chance to make every effort to perform a revision.  This procedure is unique to Dr. Sadrieh and most surgeons do not have experience or familiarity with this technique.

The decision to proceed with this kind of surgery should not be taken lightly, considering the prior surgical history and possibility of limitations that make it difficult to obtain an optimal outcome.

Possible Complications Related to Toe Reconstruction Surgery

Implant Complications

The screws, implants, or other fixation devices used in the surgery may cause discomfort, become loose, or break sometimes requiring removal.  This can also cause dislocation of the osteotomy or fusion site, which can require revision surgery.  There may also be premature breaking or wear of the Joint Replacement Implant. Prudent care of the surgical region during recovery will ensure that dislocation does not happen.  Continued awareness of your new joint will ensure you do not break it.  All synthetic materials wear with time, and although the percentage is low, it may be necessary to consider replacement of the implant if there is evidence of wear, or sustained damage or dislocation.

Necrosis

Due to the possibly complicated prior surgery results and damage to the blood vessels of the toe, the effort to reconstruct and lengthen the toe could result is necrosis, or death of the toe.  This would cause the tissues to have a lack of blood flow which could cause loss of the farthest aspect of the toe.  Every effort will be made to avoid this; statistically this is extremely rare.  Please make sure to discuss this with Dr. Sadrieh to have a better understanding of how this risk applies to your specific case.

Contraction

If there is significant swelling, scar tissue, inflammation, or breakdown of the implant material, the reconstructed toe will appear to shorten. Depending on the visual and functional outcome of this complication,, sometimes we would consider revision surgery to obtain the best outcome.