What’s the first thing that came to mind when you saw the word “cosmetic” in the title?  Was it maybe breast implants or a face lift, tummy tuck or liposuction?  These are the traditional uses of the word cosmetic and refer to correcting problems in people, who in their opinion, need to look better in order to feel better.  Over the years it has become popular for people who can afford to undergo these same surgeries to enlarge their breasts, tighten the skin of their face to reduce wrinkles, and even remove fat from areas considered to be unsightly.

In the foot people can have unsightly problems and what’s worse pain.  A bunion is a lump on the inside of the foot behind the big toe.  The size can vary and the toe can begin to move closer to and even under the 2nd toe.  When the smaller toes are buckled that is a hammertoe.  Here’s the key:  because we wear shoes, bunions and hammertoes hurt much sooner than if we went barefoot all the time.  Let me make this perfectly clear, wearing shoes does not cause the deformity, but wearing shoes does make a deformity hurt sooner than it otherwise would.

Bunion and hammertoe surgery can be cosmetic, which in my opinion means the deformity will look better after corrected so that you feel better since pain will be gone.  That’s a little bit different from other forms of cosmetic surgery.  When I perform bunion surgery or hammertoe surgery I always keep in mind the fact that you will be walking on the end result for years to come.  Because the bunion and hammertoe develop in an unstable foot I have to make sure the problem does not return.  Face lifts, tummy tucks, or breast augmentation have their long term considerations, but honestly you will not be walking, hiking, or running on these parts of your body.

There are people who want to fit into those 4” spiked heels at any cost.  They want their wide foot narrowed and long toe shortened.  I’m not talking about business executives who have to maintain a specific style of dress in order to advance their career and suffer horrible pain in these shoes.  I’m talking about people who would otherwise have no pain, but insist on wearing these heels for social purposes.  I caution those people who do not have pain!  Foot surgery can result in scar within the joint leading to stiffness and arthritis.  There is no true preventive surgery for arthritis.

One final word.  Recently a Beverly Hills Podiatrist coined the term “Cinderella Surgery” for correcting a bunion, long 2nd toe, and bunionette (on the outside of the foot) so that women can wear their high heels.  He did a very nice piece on the television show, The Doctors.  My problem is this:  I always say, feet are like snowflakes no two are alike, well here is a podiatrist telling women he can perform the same procedures on their feet in every case so they can walk immediately after surgery and their feet will fit into their stilettos.  That is just not possible without making some sacrifices.  To read about these sacrifices that might be made check back every few days for my new articles on cosmetic bunion surgery and cosmetic hammertoe surgery.  

A hammertoe is when your toe buckles or bends as a result of an unstable foot.  This can range from a mild twisting of the toe to such a severe buckling that the toe sits on the top of your foot.  Dress shoes for women and men are not made with ample room for the toes.  When a toe is buckled there is pressure and rubbing of the toe against the shoe leading to pain, redness, and formation of hard skin known as corns and calluses.

Hammertoe surgery has been described in a previous article where I talked about the difference between correcting the 2nd and 3rd toes vs. the 4th and 5th.  To review the 2nd and 3rd toes usually involve toe fusion surgery, while the 4th and 5th involve toe joint surgery where the joint is removed.  Muscles and tendons are often rebalanced around the base of the toe and sometimes work further back in the metatarsal is needed.  Cosmetic surgery on a hammertoe can mean hiding the scar or just the fact that I will make your toe look better.

Many people have one toe longer than the others and consider this unsightly.  Mind you this toe is not buckled and not painful, but some people want this toe shortened.  A doctor might decide to remove some bone from the toe shortening this long toe and performing toe fusion surgery thinking he is making the toe stable.  Unfortunately there are tendons in each and every toe that are not shortened with the toe because tendons don’t heal well.  Tendons rely on being a specific length, for geeks like me that would be 125% of the muscle/tendon resting length, in order to work.  So yes I can shorten your toe and in turn I have just made your toe unstable.  I might have performed toe fusion surgery to make that toe joint stable, but the other joints are not, so your toe buckles and now you have a toe sticking straight up in the air.  Would that be worth it to you?  As the podiatrist who spends a great deal of time fixing poor surgical outcomes, I can tell you it is much more difficult for me to correct this problem.

What exactly do I mean by hiding your scar?  Most hammertoe surgery is done through the top of the toe.  This is beneficial if I have to address the tendons, ligaments, joint capsule, and even bone at the base of the toe or metatarsal.  If your toe can be treated just by toe joint surgery alone than I can make the incision on the side of your toe so that no one will ever see your scar.  The sacrifice I am making to use this incision is that I cannot rebalance the joint in the ball of your foot.  If your toe is buckled and you have pain in the ball of your foot do not expect a scar any where other than the top of your toe.

Cosmetic hammertoe surgery means making your toe look better and relieving pain.  I have talked about some of the risks and sacrifices that are involved in making this decision.  Remember what I always say, feet are like snowflakes, no two are alike.  Your surgery will be different from your friends and it should be.  Don’t forget to read the articles on toe surgery without the pin and recovery from hammertoe surgery.

screw and absorbable pin

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.

smart toe

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.

I guess it’s the training I received combined with a dry sense of humor and no nonsense approach that filled my practice with patients other doctors considered too hard to heal.  Because of the level of patient I treat at Desert Foot Surgeons, I take your recovery seriously as should you.  The most prefect surgery can still hurt, swell, and even go horribly wrong if you’re not on the same page as your doctor.  I have many patients who can run a mile in under 6 minutes, but their recovery might not be as fast as a patient who smokes.  If we work together, even patients with diabetes who have sores on their feet can heal.

With that said, recovering from hammertoe surgery is usually not that hard.  You should do a few thins to make sure that your healing experience is the most pleasant possible.  Before your surgery is the most important time.  The more you can do for yourself before surgery, the happier you will be after.  Simple things like preparing meals before hand, practicing walking in your special shoe or boot, and planning for time spent resting your foot.

What room in your home worries me most?

Believe it or not it’s your kitchen.  Those kitchen cabinets have that little ledge at the bottom.  Be careful not to hit your toes against this edge.  The shoe or boot you will be wearing is higher than regular shoes and has grabbed hold of more than one of my patients’ bandages.  That’s a good reason to prepare meals before your surgery, but the real reason is you are recovering from surgery.  You shouldn’t have to cook for yourself.  Give yourself at least a little few meals off to rest and stay off your foot.

Since we’re talking about hammertoe surgery most of you will be allowed to walk, but in a special shoe or boot.  You might not think this is going to be hard, but if you’re weak this can be a challenge.  I can send you to physical therapy before the surgery to be sure you can handle the shoe or boot.  This way you and I know exactly what to expect after surgery.  I can even prescribe a strengthening program for you through physical therapy if you need.

Easier Hammertoe Recovery

Other things that can make your recovery from hammertoe surgery easier include getting your house set.  Firsts of all, do you have stairs?  If walking on flat floors is hard in the shoe or boot, stairs might be impossible.  You might want to sleep downstairs the first few days.  You will need to clear a path to the bathroom.  Think about removing area rugs that can slip and slide out from under foot.  Small tables and chairs can have legs that stick out, which could bump your toe.  Think about the ways you can set up your house to help you recover.  My staff has many more ideas that they will be glad to share with you.

Before surgery we developed a plan to help you heal as fast as possible.  After your surgery you need to stick to the plan.  The game plan we designed together before surgery will be given to you in writing.  Obviously there will be a special shoe or boot and pain medication that you should have before you get to the hospital.  That leaves swelling and pain to discuss.  A toe is small and there is not much room for swelling.  The more your foot is down, the more it will swell.  Since there is so little space in the toe this swelling can hurt.  Both of us want your surgery to be as free of pain as possible.  You will need to rest with your foot up.  That means lie flat on the couch or bed and put your feet on pillows.  Make sure your knees are bent a little so this is more comfortable.  Ice can go behind your knee or at the inside of your ankle to prevent swelling.  The ice should be on 20 minutes and then off for 40 minutes.  This can be repeated as often as needed, but usually no less than 3 times per day for the first 3 days.

I like to prepare before surgery as much as possible.  I tell my residents to review a surgery in their mind 5 times before they even step into the operating room.  If your surgeon prepares before surgery shouldn’t you?  I hope this information shows you how Desert Foot Surgeons helps you heal after hammertoe surgery.  Remember, feet are like snowflakes, no 2 are alike.  Choosing your foot surgeon is very important.  Your surgeon needs to have the training and artistic talent to fix your toe.  Equally as important is your ability to communicate with your surgeon.  Ask questions and prepare before your surgery.  You’ll be glad you did.

So you’re at the point where you need surgery to fix your hammertoes and you want more information.  They way I fix your toe depends on the cause and there are 3 causes of hammertoes.  These different causes make the toes bend and twist in different directions.  Your 2nd and 3rd toes will bend in a straight line, but your 4th and 5th toes twist as they bend so the nail doesn’t sit on top of the toe any more.  Just to clarify, your little toe is #5 and your big toe is #1.  Counting from your big toe to the little toe goes 1, 2, 3, 4, and 5.

Let’s start with your 4th and 5th toes.  Unfortunately shoes press the hardest on your 4th and 5th toes.  Because of this constant pressure I can’t make these toes stiff or you would never wear shoes again without pain.  In fact, your 4th and 5th toes are fixed by removing the crooked joint and leaving the toe flexible.  Removing the joint will fix the bend, but does nothing to fix the twisting so I have to use a carefully planned skin incision to un-twist your toe and bring the nail back on top.  The bandages will help to hold your toe in this position since there are no screws or pins, so it is very important that you do not remove your bandages.  To prevent the tendons from pulling on your toe you must wear a special shoe or boot.  You will be allowed to walk after the surgery as long as you wear this shoe or boot, but remember that the more time you spend walking around on your foot after surgery the worse the swelling and pain will be.  Stitches are removed after 10 days and you will wear a loose fitting tennis shoe before you return to tighter shoes.  I expect swelling to last 3-6 weeks, but a lot of that depends on your body.

Your 2nd and 3rd toes are more complicated to fix than the 4th and 5th because they buckle for a different reason.  Because of this difference I have to treat these toes using another approach.  Your 2nd and 3rd toes must be made stiff so that the muscles won’t cause the toe to buckle again after it has been fixed by surgery.  That means that after the surgery your 2nd and 3rd toes will not bend at the toe joint.  You will have a screw or pin in your toe to hold the bones straight.  The screw or pin can be removed in the office at a later date if needed.  No doubt you have heard stories about people having pins sticking out of their toes after hammertoe surgery.  I use newer technology when I can so that you won’t have anything sticking out of your toe.  It is still important that you not change the first set of bandages after surgery.  In straightening your 2nd and 3rd toes I am removing the crooked joint and making the bone ends heal together.  You will be able to walk using special cast boot, but again the amount you walk determines how much swelling and pain you get.  The bone takes about 1 month to heal.  Tennis shoes are easier to wear at first and as swelling and pain subside you can progress to the shoes you want, within reason.

That’s the scoop on the most common hammertoe surgeries.  I’ve told you how fixing your 4th and 5th toes are different from your 2nd and 3rd.  You have an idea of what to expect after surgery.  I have not told you about the more complex toe problems, but will in future posts.  For now remember what I always say, “feet are like snowflakes, no two are alike”.  The surgical approach from one foot to another has to be different, that’s the art of surgery and is one of the main things separating me from other foot surgeons you might meet.

Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.

The treatment differs based on the stiffness of the bent toe. Smaller toes such as the 4th or 5th that can be straightened by hand often can be treated by simple tendon release. This is the easiest hammertoe surgery to recovery from often requiring a single stitch. If more than one toe is done at a time the recovery can be slightly longer.

If the bend in the toe cannot be straightened by hand, removal of the rigid joint is performed. At Geller Podiatry we employ a detailed step-wise approach to straighten all parts of the toe. The more deformed the toe, the more steps will be used from simply fusing the toe joint straight to breaking the metatarsal head and repositioning the entire toe. Tight skin has to be lengthened using plastic surgery techniques so that the toe can stay straight and the scar is more cosmetic. In general these procedures require protection from walking using a cast boot. X-rays are used to follow the toe healing process and you will be returned to shoes when your doctor sees evidence of bone healing.

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