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Mallet Toes

In mallet toe, the joint at the end of the toe buckles. The skin near the toenail tip develops a painful corn that can eventually result in an ulcer. These can be extremely painful. The toe can become red and swollen. Because the second toe is typically the longest, it is the most likely to be affected by mallet toe.

Two types of mallet toe exist:

  • Flexible mallet toes are in the developmental stage and the affected toes are still moveable at the joint.
  • Rigid mallet toes are more symptomatic. The tendons tighten and the joints become misaligned and fixed in this position.

Symptoms of mallet toe include:

  • Redness and swelling on the affected toe.
  • Corns or calluses.
  • Toe ulcers in diabetic patients.

What causes mallet toes?

Mallet toe can result from the following:

  • Injury to the toe.
  • Shoes that are too tight.
  • Bone and muscle imbalances.
  • Arthritis.

How is this treated?

Non-surgical treatment of mallet toe includes:

  • Rubbing calluses with a pumice stone to keep them as thin as possible.
  • Wearing shoes with roomy toe boxes.
  • Wearing a cushioned pad over the toe, or beneath the toe tip.
  • Avoiding high heels.
  • Strengthening and stretching the toe muscles with exercises.

What are the risks of treatment?

Risks include nerve injury, infection, and stiffness. Recurrence of the toe deformity can occur, especially if you return to wearing ill-fitting shoes.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Refrain from eating or drinking anything after midnight the night before surgery.

Are there exercises I can start now prior to surgery?

In preparation of any foot/ankle surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin on the morning of surgery.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

Your foot will be initialized in the preoperative area by someone from the surgical team. In the operating room, you will be met by a nursing team and the anesthesia team. You have several anesthetic options:

  • General: Completely asleep and breathing through a tube
  • Epidural/Spinal: Numb from the waist down, or
  • Local: Numbing medicine just above the surgical site

Epidural/Spinal and Local are usually combined with sedative medication so you can rest comfortably during the procedure. Once you are anesthetized, the surgery is initiated.

The aim of surgery is to realign the toe, which may include:

  • Cutting or lengthening tendons
  • Removing a portion of the bone to realign the toe
  • Inserting a steel pin to hold the corrected position of the toe
  • Amputating the affected toe

What happens after surgery?

It is not unusual to experience numbness, tingling, and burning sensations in your foot or ankle. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problem, your cast or surgical dressing may be too tight, and you may need to call your doctor. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your doctor.

Your doctor will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery.

If you are wearing a cast, do not put anything in the cast and keep the cast clean and dry. If you are itching beneath the cast, take Benadryl and blow cool air down the cast with a hair dryer.

Follow-up X-rays may be required to ensure the foot is healing properly. These are usually done 3-6 weeks after surgery. Additionally, patients are typically required to wear a post-operative shoe. If a pin is in the foot, then it is important not to bear weight on the forefoot, or the pin can bend or break.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period?

Full recovery typically requires between 6 and 12 weeks. Swelling is the "enemy" after surgery and precautions must be taken to minimize it. A slow, gradual return to activities is encouraged.

What kind of rehabilitation takes place after surgery?

Foot and ankle surgery rehabilitation can be done at home, or, may require formal physical therapy.

How can I manage at home during recovery?

After the first 48 hours of foot elevation, you can usually gradually return to most activities. However, the use of crutches or a walker will be required. At some point, your physician will allow you to wean off the crutches/walker to more "normal" activities. Typically, the dressing placed at the time of surgery is left intact until your first postoperative visit. The surgical dressing cannot get wet. Therefore, baths are encouraged. If one chooses to shower, then an “over-the-cast” bag is necessary.

How frequently should I schedule follow up appointments with my doctor following surgery?

Follow-up visits are scheduled by your surgeon.

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