Friday, December 26, 2008

Fearing Pins with Bunion and Hammertoe Surgery

Today I got a question from a patient who is thinking about surgery for bunions and hammertoes. She explained that a friend of hers had a similar surgery. She said that her doctor pinned the hammertoes. In addition, he put a plaster cast around the front half of the foot. Her friend was wearing a surgical shoe, but that the pins and cast would have to stay in place for at least 5 weeks!

So the question is… is it necessary to have pans sticking out of the end of the toes after you have hammertoe surgery. The other question is how long does it take for someone to really recover.

There are many ways to fix hammertoes. In the cases described here, the patients also had bunions and decided to have surgery to fix both of those problems at the same time. Many times as a bunion forms, the big toe will move over against the second toe and push the toe out of alignment. This causes the hammertoe deformity.

If this is the case, fixing the hammertoe alone is not a good idea. Without fixing the bunion that is pushing into the second toe, the hammertoe deformity is likely to develop again.

When the hammertoe is straightened, something has to be done to keep the toe in alignment while it heals. One way to do this is to drive a pin in the end of the toe through all of the bones in shish kebab fashion. I personally don’t like this method. Although it is simple and inexpensive, it does have additional risks.

A pin sticking out of the end of the toe is a portal for bacteria and can lead to an infection. Whenever you walk or move the foot, the skin moves back-and-forth across the pin. Over time, the bacteria that normally grows on the skin can work its way down the pin as it pistons relative to the skin.

Because the pin is driven into the bone, this can lead to bone infection. Bone infections, also known as osteomyelitis, are very difficult to treat and often lead to amputations. This is a very serious complication.

A better way to correct a hammertoe is to put an implant in the joint that is corrected when the foot surgeon out the toe. This implant is completely contained within the toe. There is no exposed tendon and no additional risk of contracting an infection. There are both absorbable and nonabsorbable implants available to surgical podiatrists for this procedure. The nonabsorbable implants are typically made of titanium or surgical stainless steel.

These implants do cost more than the pin that’s typically left sticking out of the end of the toe. Medicare will not pay for these types of implants. For my patients, this is no longer a problem is I have decided to opt out of Medicare. I believe it’s important to make sure the patient has the best treatment available, not just the cheapest treatment.

Regardless of which method you and your foot doctor choose, it does take about six weeks for the corrected hammertoe to heal. It is necessary to wear either a surgical shoe or a fracture walking boot while you recover. Most people can walk while they are recovering. It’s not always necessary to use crutches.

If the pin is sticking out of the end of the toe, it is typically necessary to leave in place anywhere from four to six weeks. Much of this depends on the patient’s age, how well the person is recovering, and whether or not an infection develops.

Although this can be an inconvenience, there are other methods. It’s important to discuss your expectations and desired activities with your foot surgeon before you have any foot surgery. Making sure that you understand what will be required for you to recover, to make sure that you can get back to activities you enjoy as quickly as possible.

Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.

7 comments:

elisasilkwood said...

Dear Dr. Segler,

I had severe bunion/hammertoe surgery on both feet on July 25 2008. My doctor removed bone in every toe except my big toes to correct the hammertoes. She fused the bones back together and then placed pins in that were sticking out. The pins were removed after 6 weeks. Since she fused the bones together in each toe, my toes no longer bend. My question is, since my toes do not bend now, I am having a hard time with all of my shoes that slip on due to the no longer can grip. Is there anything that I can put in my shoes to help keep them on?

Sincerely,
Elisa Silkwood

My Running Doc said...

Dear Ms. Silkwood,

The procedure that it sounds like you describe is called digital arthrodesis. The name of course comes from "digital" for toes, "arthro" for joint, and "-desis" for fusion. It is one of the procedures I choose most often for hammertoe correction.

Fusion of one of the joints in the toes can provide very stable correction of the hammertoe contracture with predictable long-term results. By removing the joint and fusing it, it is almost impossible for the hammertoe deformity to return.

One of the limitations of the procedure is that you get stability, but only in exchange for flexibility. Sometimes this can mean a decreased ability to grip with the toes.

Given the relatively short time since your surgery, it is possibility that through rehab (home exercises and physical therapy) you might regain some grip strength. This can improve for up to 18 months after hammertoe surgery as everything heals.

In the short term, you might benefit from a gel crest pad. Although these are typically used to straighten hammertoes or decrease pressure from hammertoes, it might serve you well. In your case, it sound like it might give you the little extra grip you need just by taking up a small amount of space in the shoe. It is of course impossible for me to tell without an examination, but you can paste the link into your browser to see what a picture and get an idea: http://www.OurDoctorStore.com/anklecenter/store/item.asp?ITEM_ID=497&MANUFACTURER_ID=27 You can likely purchase these locally in you own podiatrist's office.

I would encourage to discuss this possibility with your foot surgeon before attempting to use crest pads. It is essential that your podiatrist agrees that this is a good idea. There is a chance that early use of such a pad could cause you to lose correction or develop other problems if you have not fully healed and been cleared by your physician to use this sort of device. Always talk to your foot surgeon first.

I will say that the procedure you and your doctor have chosen is the one I would choose for myself, if I were to need hammertoe corrective surgery.

Thank you for reading, and for commenting on our blog!

Best of luck,
Dr. Christopher Segler
Chattanooga's Award Winning Podiatrist

chocolatecake89 said...

Hi Dr.Segler

I have a toe deformity, but i have no idea what its called. I have a bunion on both feet, and sine i was younger, my toes were very weird. Both the big toes are very curved. If i put my feet together, both my big toes are no where near each other, shaped like a "V". Then the second toes and also curved in that direction and the nail of my second toe is facing the back of my big toe. It soooo embarassing and i would like to fix it but i know its gonna take a long time to recover and i just dont have time to spare right now. Can u please tell me what this might be called?, just so i can have a better understanding of my little situation. i want to wear open toe shoes and cute colorful sandals soo bad but i just cant take the staring. :-/

thank you soooo much :-)
-M. McFarlane

Pat Cannedy said...

I had bunion and hammertoes surgery t 10 weeks ago. After they took the stiches out, my baby toe that was not pinned; elevated. Now I have to have surgery on my baby toe to release the tendon. Is this common?

Ni Sea said...

I had my surgery on July 19, 2013. I had two bunions fixed on my left foot plus 2nd, 3rd and 4 the hammer toe repair. I have been in severe pain I cannot walk or stand how long does this last for

Pat Cannedy said...

It took about 6 weeks to 3 months to feel better. However, I have a space between first and second toe. So I am not happy with the results. I had pins in four toes, so I could not walk on the foot till the pins were removed. It took a long time to walk or stand. Did dr tell you about this?

Maureen Williams said...

I had hammer toe surgery on my right foot second toe. My doctor opted to place a titanium pin in the toe to prevent it from bending and thus having the same problem in the future. I am 1 month post op and have the following concerns about the surgical toe: The movement is limited in comparison to the other toes, the toe is a bit fatter than the same toe on the other foot. My questions are: Is the toe still likely swollen and will decrease to normal size? Will the movement get better (later) than it is now? Can the pin be removed without and issue?