top of page

Lesser Toe Surgery

Lesser toe surgery refers to a range of procedures performed to correct painful deformities affecting the second, third, fourth, or fifth toes. Common conditions requiring surgery include:

​

  • Hammer toe – A bent toe at the middle joint.

  • Claw toe – A bent toe at both the middle and end joints.

  • Mallet toe – A bent toe at the end joint.

  • Crossover toe – A toe drifting over the adjacent toe.

  • Floating toe – A toe that does not touch the ground properly.

 

These deformities often cause pain, corns, calluses, difficulty wearing shoes, and instability when walking. Surgery is considered when non-surgical treatments fail to provide relief.

What Does the Surgery Involve?

Lesser toe surgery is performed under local, regional, or general anesthesia. The specific procedure depends on the deformity and severity:

 

Common Surgical Techniques:

  1. Tendon Release (Tenotomy) or Transfer

    • For flexible deformities.

    • The tight tendon pulling the toe out of position is released or repositioned.

  2. Joint Removal (Arthroplasty)

    • For rigid deformities.

    • A small section of the toe joint is removed to allow the toe to straighten.

  3. Toe Fusion (Arthrodesis)

    • For severe deformities.

    • The bones of the toe are fused to permanently straighten it.

  4. Weil Osteotomy (Metatarsal Shortening)

    • If the metatarsal bone is too long, part of it may be removed to redistribute pressure.

  5. Soft Tissue Repair (Capsuloplasty/Plantar Plate Repair)

    • If the toe is unstable or drifting, the supporting soft tissues are repaired or tightened.

 

Metal pins, screws, or sutures may be used to hold the correction in place while the toe heals.

Alternative Treatments

Before considering surgery, non-surgical treatments may help manage symptoms:

​

  • Footwear Modifications – Wide, deep shoes reduce pressure on the toes.

  • Toe Pads or Splints – Can help protect painful areas and slow progression.

  • Custom Orthotics – Insoles may improve toe positioning and pressure distribution.

  • Callus and Corn Management – Regular podiatry care can reduce discomfort.

  • Stretching and Taping – May temporarily relieve symptoms in flexible deformities.

 

Surgery is recommended when non-surgical measures fail and pain or difficulty walking becomes significant.

Risks and Complications

Lesser toe surgery has a high success rate, but some risks exist:

 

General Surgical Risks:

​

  • Infection (1–3% risk) – More common in diabetics and smokers. Usually treated with antibiotics.

  • Blood Clots (DVT/PE) – Uncommon but possible, particularly if mobility is reduced.

  • Nerve Injury – Temporary or permanent numbness around the toe.

 

Procedure-Specific Risks:

​

  • Stiffness or Over-Correction – The toe may become too straight or rigid.

  • Swelling and Scar Sensitivity – Common for several months post-surgery.

  • Nonunion (Failure of Fusion) – If a fusion does not heal properly, revision surgery may be required.

  • Floating Toe – The toe may not touch the ground properly, especially after metatarsal shortening.

  • Recurrence of Deformity – If underlying causes (e.g., tendon imbalance) are not fully corrected, the deformity may return.

  • Prominent Metalwork – If screws or pins become uncomfortable, they may require later removal.

 

Most patients experience good pain relief and functional improvement, but toes may not always look perfectly straight.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 1–2 weeks

  • Manual labor: 4–6 weeks

 

Return to Driving

  • 4–6 weeks, depending on swelling and pain.

 

Return to Activities & Sports

  • Walking unaided: 4–6 weeks

  • Running or high-impact activities: 8–12 weeks

 

Rehabilitation Timeline

  • Weeks 0–2:

    • Weight-bearing depends on the procedure (protected walking in a post-op shoe).

    • Toe elevation to reduce swelling.

  • Weeks 2–6:

    • Gradual return to normal footwear (soft, wide shoes first).

    • Physiotherapy may be started for mobility.

  • 6+ weeks:

    • Resume daily activities and sports as tolerated.

    • Minor swelling may persist for several months.

 

With proper healing, most patients achieve significant symptom relief and improved toe alignment.

bottom of page