Transverse toe deformities, such as hammer or claw toes, can cause discomfort and difficulty with footwear. A closing wedge osteotomy of the proximal phalanx is a surgical procedure designed to alleviate these issues by reducing pain and improving toe alignment. Here’s an overview of the procedure and what to expect during recovery.
What is Closing Wedge Osteotomy of Proximal Phalanx?
This procedure involves removing a small wedge of bone from the proximal phalanx (the bone closest to the foot) to straighten the affected toe. If necessary, the joint at the base of the toe may be released, and the tendon lengthened to enhance correction. In some cases, a stabilising wire is used to maintain the new alignment during healing. This wire is typically removed during a follow-up appointment.
The surgery usually takes 15 to 30 minutes and does not typically require a cast.
Why Consider This Surgery?
The main goals of the procedure are:
To reduce pain caused by toe deformities.
To straighten the affected toe.
To minimise the formation of calluses or corns.
Advantages:
Maintains some mobility in the affected toe.
Risks and Considerations
While the procedure is effective, specific risks include:
Recurrence of the deformity.
The toe may not touch the ground (floating toe).
Pain around the surgical site.
Loosening of screws or pins (if used), potentially requiring removal.
Long-term swelling of the toe.
Malalignment of the toe.
Your consultant will discuss these risks with you and explain the steps taken to minimise them.
Who is a Candidate for This Procedure?
This surgery is recommended for individuals experiencing:
Painful hammer or claw toe deformities.
Painful corns or calluses caused by toe misalignment.
Difficulty finding comfortable footwear despite wearing sensible shoes.
Alternative Treatments:
Changing activity levels.
Using painkillers or anti-inflammatory medications.
Altering footwear styles or using toe protectors.
Regular podiatry care to manage symptoms.
What to Expect During Surgery
The procedure is typically performed under local anaesthesia, ensuring you remain awake but pain-free. If necessary, sedation or general anaesthesia may be used. You will spend some time in the day surgery unit both before and after the procedure to rest.
A responsible adult must accompany you home and assist you for the first 24 hours post-surgery.
Recovery Timeline
Initially (First 2 Weeks):
Pain is most pronounced during this period, but prescribed painkillers will help manage discomfort.
Rest is essential. Keep your foot elevated and minimise movement.
Use crutches as instructed to limit weight-bearing on the operated foot.
Two Weeks After Surgery:
Attend a follow-up appointment to check your progress and remove sutures if necessary.
X-rays may be taken to assess healing.
You may be fitted with a new dressing or air cast boot if required.
2-8 Weeks After Surgery:
Gradually increase activity levels as advised by your healthcare team.
Swelling and mild discomfort are common but should gradually improve.
Wear supportive lace-up shoes or trainers and start walking as tolerated.
Rehabilitation exercises may be introduced, or a referral to a physiotherapist provided.
8-12 Weeks After Surgery:
The foot should feel more functional and natural.
Swelling continues to reduce.
Sporting activities may be considered, depending on recovery progress.
Beyond 12 Weeks:
Attend a final review 6-8 months after surgery.
Improvements in alignment and pain relief will continue to be noticed.
Planning for Recovery
To ensure a smooth recovery:
Arrange for assistance with daily tasks during the initial weeks post-surgery.
Follow all post-operative care instructions provided by your surgical team.
Attend all scheduled follow-up appointments to monitor healing.
Closing wedge osteotomy of the proximal phalanx is an effective procedure for correcting transverse toe deformities and relieving associated discomfort. By adhering to recovery guidelines and working closely with your healthcare team, you can achieve significant improvements in mobility and quality of life. If you are considering this procedure, consult your healthcare provider to determine if it is the right option for you.