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What is MIS Hammertoe Surgery?

A hammertoe, also called mallet toes or claw toes, is a deformity of any of the lesser toes (second through fifth toes), where the toe gets bent upward at the toe’s middle joint, resembling a hammer. It occurs as a result of imbalance in the ligaments and tendons that support the toe’s position. Hammertoes can be caused by ill-fitting footwear, trauma, genetics, foot structure, and as a complication of arthritis and certain neuromuscular conditions.

Standard open surgery to correct hammertoes generally involves making large incisions to cut, lengthen or transfer tendons and/or excise or fuse the joints of the toes. Fixation devices such as screws, pins, and wires are often required to hold the toes straight and the toes tend to be very stiff post surgery.

On the contrary, MIS or minimally invasive surgery for hammertoe is a surgical procedure carried out through tiny incisions using very fine instruments, rather than a large, open incision as in traditional surgery. Screws and pins or wires are not required and the alignment is achieved using tape and wrapping.

Benefits of MIS hammertoe surgery over traditional hammertoe surgery include:

  • Small incisions
  • Shorter recovery period
  • Shorter hospital stay
  • Reduced postoperative pain
  • Minimal blood loss
  • Minimal muscle trauma
  • Less scaring
  • Earlier mobilization
  • Faster healing time

Indications for MIS Hammertoe Surgery

Your surgeon may recommend MIS hammertoe surgery if:

  • You have significant pain that limits your activities of daily living (ADL)
  • Your pain is persistent and getting worse.
  • It is painful to stand or walk on your feet.
  • It is difficult to wear shoes.
  • Failure to obtain pain relief with changes in footwear.
  • Nonsurgical treatment modalities such as physical therapy and orthotics have failed.

Preparation for MIS Hammertoe Surgery

Preoperative preparation for MIS hammertoe surgery may involve the following steps:

  • A review of your medical history and a physical examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the surgery and to design a personalized plan based on the specifics of an individual’s foot anatomy.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to stop taking medications such as blood thinners and anti-inflammatories, or other supplements for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as it can hinder the healing process.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You should arrange for someone to drive you home after surgery.
  • A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for MIS Hammertoe Surgery

Minimally invasive surgery for hammertoe is typically performed as a same-day surgery under light sedative or local anesthesia rather than general anesthesia, hence you will remain conscious throughout the procedure. In general, the procedure will involve the following steps:

  • The skin over the hammertoe is cleaned with an antiseptic solution.
  • Small incisions are made over the treatment area with the aid of specialized instruments.
  • Minimally invasive correction involves surgery to the soft tissues and/or bones and joints.
  • Surgery to the soft tissues may involve releasing/lengthening tendons and releasing tight joints.
  • Surgery to the bones involves osteotomies (making tiny incisions) to re-align them utilizing specialized burrs (tiny drills). In some cases, it is essential to operate on the small joints of the toes (distal and proximal interphalangeal joints) which can be fused to correct the deformity in some situations.
  • The desired toe alignment is maintained using taping and wrapping every 2 weeks until 6 to 8 weeks postoperatively, thereby eliminating the need for screws, pins, or wires to maintain the correction.
  • The incisions are closed with stitches or surgical tape and a sterile dressing is applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery will involve the following:

You will be transferred to the recovery area where your nurse will closely monitor your vital signs as you recover from surgery.

  • You may notice pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed to address these.
  • Keep your foot elevated as much as possible for the first few days after surgery to reduce swelling and you may apply ice as needed to relieve pain and swelling.
  • You will be placed on assistive devices such as crutches or a walker to assist with walking and a special post-operative shoe to enable weight-bearing. Full weight-bearing is healthy for the foot as it enables the soft tissue and bone to self-adjust to the flat surface.
  • You may gradually increase the amount of walking, and crutches or walkers can be weaned off at 2 weeks.
  • You can return to normal running shoes at 6 weeks. Higher-impact activities and sports can start at 10 weeks.
  • Physical therapy and range of motion exercises will be gradually started to condition and strengthen the foot.
  • Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
  • You may resume driving once you can comfortably walk and you are off all pain medications.
  • You should strictly adhere to all scheduled follow-up appointments to monitor your progress.

Risks and Complications

MIS hammertoe surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Pain and discomfort while walking
  • Swelling
  • Infection
  • Bleeding
  • Nerve injury
  • Blood clots or DVT
  • Poor alignment of the toe

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